MEDICARE: ABDISALLAM AHMED ABDULLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor	494734	MN

General Provider Information

NPI Number	:	1558875856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDISALLAM AHMED ABDULLE

Provider Business Mailing Address
First Line	:	8609 LYNDALE AVE S STE 213C
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55420-2769
Country	:	US
Telephone Number	:	612-200-9466
Fax Number	:

Provider Business Practice Location Address
First Line	:	8609 LYNDALE AVE S STE 213C
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55420-2769
Country	:	US
Telephone Number	:	612-200-9466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2017
Last Update Date	:	11/22/2017

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