MEDICARE: RUWAIDA ALI

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1912614710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUWAIDA ALI

Provider Business Mailing Address
First Line	:	647 13TH AVE E
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-3328
Country	:	US
Telephone Number	:	701-277-8844
Fax Number	:

Provider Business Practice Location Address
First Line	:	427 W TRAVELERS TRL
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-2554
Country	:	US
Telephone Number	:	952-247-2954
Fax Number	:

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

Provider Enumeration Date	:	11/01/2022
Last Update Date	:	09/19/2025

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