Provider Demographics
NPI:1083451603
Name:ADEM, AMENA (HEALTH INFORMATION)
Entity type:Individual
Prefix:
First Name:AMENA
Middle Name:
Last Name:ADEM
Suffix:
Gender:F
Credentials:HEALTH INFORMATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 HEATH AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5204
Mailing Address - Country:US
Mailing Address - Phone:651-273-4500
Mailing Address - Fax:
Practice Address - Street 1:400 S 4TH ST STE 401
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1419
Practice Address - Country:US
Practice Address - Phone:651-494-8254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health