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NPI Code Detail

MEDICARE: ETHIL JAMA MOHAMED

MEDICARE: ETHIL JAMA MOHAMED
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1982548517
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHIL JAMA MOHAMED
Provider Business Mailing Address
First Line : 3500 E LAKE ST STE 100
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-2151
Country : US
Telephone Number : 612-298-2169
Fax Number :
Provider Business Practice Location Address
First Line : 3500 E LAKE ST STE 100
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-2151
Country : US
Telephone Number : 612-298-2169
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2026
Last Update Date : 04/15/2026

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Directions to “ ETHIL JAMA MOHAMED ” Practice Location

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