Provider Demographics
NPI:1972745800
Name:KHAN, YASMEEN AMINA (DC, MS, MA)
Entity type:Individual
Prefix:MS
First Name:YASMEEN
Middle Name:AMINA
Last Name:KHAN
Suffix:
Gender:F
Credentials:DC, MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1617
Mailing Address - Country:US
Mailing Address - Phone:563-328-5832
Mailing Address - Fax:
Practice Address - Street 1:415 N PERRY ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1617
Practice Address - Country:US
Practice Address - Phone:563-328-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007189111N00000X
IA095817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty