Provider Demographics
NPI:1225842115
Name:OUTTALEB, HASSAN
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:OUTTALEB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 PLAZA DR STE 17
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2613
Mailing Address - Country:US
Mailing Address - Phone:612-716-8019
Mailing Address - Fax:
Practice Address - Street 1:1875 PLAZA DR STE 17
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2613
Practice Address - Country:US
Practice Address - Phone:612-716-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst