Provider Demographics
NPI:1699561183
Name:OMAR, SALMA ADAM
Entity type:Individual
Prefix:
First Name:SALMA
Middle Name:ADAM
Last Name:OMAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 25TH AVE N STE B1-119
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-3222
Mailing Address - Country:US
Mailing Address - Phone:320-492-6960
Mailing Address - Fax:
Practice Address - Street 1:510 25TH AVE N STE B1-119
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-3222
Practice Address - Country:US
Practice Address - Phone:320-492-6960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician