Provider Demographics
NPI:1972330116
Name:AZEREFEGN, EDEN MEKBIB
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:MEKBIB
Last Name:AZEREFEGN
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 1:931 20TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4652
Mailing Address - Country:US
Mailing Address - Phone:763-324-8284
Mailing Address - Fax:
Practice Address - Street 1:931 20TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-4652
Practice Address - Country:US
Practice Address - Phone:763-324-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst