Provider Demographics
NPI:1992414163
Name:SAGAL-CIISE, HABIBA MAXAMUD
Entity type:Individual
Prefix:
First Name:HABIBA
Middle Name:MAXAMUD
Last Name:SAGAL-CIISE
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 1:1225 20TH ST SE APT 305
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-6501
Mailing Address - Country:US
Mailing Address - Phone:507-517-9887
Mailing Address - Fax:
Practice Address - Street 1:1225 20TH ST SE APT 305
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6501
Practice Address - Country:US
Practice Address - Phone:507-517-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker