Provider Demographics
NPI:1063943470
Name:HASSAN, ASHWAK (MA)
Entity type:Individual
Prefix:
First Name:ASHWAK
Middle Name:
Last Name:HASSAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 42 1/2 AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3157
Mailing Address - Country:US
Mailing Address - Phone:612-987-5578
Mailing Address - Fax:612-435-9199
Practice Address - Street 1:966 42 1/2 AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3157
Practice Address - Country:US
Practice Address - Phone:612-987-5578
Practice Address - Fax:612-435-9199
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3261106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist