Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1962049478 |
---|---|
Provider Name | Amal Yusuf Warsame |
First Address | St Louis Park, MN 55416-4758 |
Second Address | St Louis Park, MN 55416-4758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2019 |
Last Update Date | 03/12/2019 |