Provider Demographics
NPI:1316279664
Name:ADEM, SAMIYA (BCBA, PHARMD)
Entity type:Individual
Prefix:
First Name:SAMIYA
Middle Name:
Last Name:ADEM
Suffix:
Gender:F
Credentials:BCBA, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 UNIVERSITY AVE W STE 150
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1629
Mailing Address - Country:US
Mailing Address - Phone:720-519-9476
Mailing Address - Fax:
Practice Address - Street 1:2233 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1600
Practice Address - Country:US
Practice Address - Phone:205-199-4767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAB61477660106E00000X
WAPH60284830183500000X
1-24-77007103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No183500000XPharmacy Service ProvidersPharmacist