Provider Demographics
NPI:1215676382
Name:ADEN, OSOB ISSAK
Entity type:Individual
Prefix:
First Name:OSOB
Middle Name:ISSAK
Last Name:ADEN
Suffix:
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 1:8609 LYNDALE AVE S STE 201D
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2754
Mailing Address - Country:US
Mailing Address - Phone:763-732-9476
Mailing Address - Fax:
Practice Address - Street 1:8609 LYNDALE AVE S STE 201D
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2754
Practice Address - Country:US
Practice Address - Phone:763-732-9476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician