Provider Demographics
NPI:1063190387
Name:HUSSEIN, SUMAYA SAEED I
Entity type:Individual
Prefix:
First Name:SUMAYA
Middle Name:SAEED
Last Name:HUSSEIN
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2893 128TH LN NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6322
Mailing Address - Country:US
Mailing Address - Phone:612-226-5286
Mailing Address - Fax:
Practice Address - Street 1:2893 128TH LN NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6322
Practice Address - Country:US
Practice Address - Phone:612-226-5286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNP000-080-596-500106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician