Provider Demographics
NPI:1386407377
Name:HUSSEIN, ILHAM
Entity type:Individual
Prefix:
First Name:ILHAM
Middle Name:
Last Name:HUSSEIN
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 1:97 BLAKE RD N APT 330
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8296
Mailing Address - Country:US
Mailing Address - Phone:507-412-9371
Mailing Address - Fax:
Practice Address - Street 1:3055 OLD HIGHWAY 8 STE 190
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2595
Practice Address - Country:US
Practice Address - Phone:612-267-6293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician