Most Relevant Information
Provider Data
| NPI Number: | 1003412099 |
| Provider Name: | IDIL MOHAMED HIRSI |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/07/2020 |
| Last Updated: | 12/07/2020 |
Provider Practice Location
9806 GLACIAL VALLEY ALCOVE
WOODBURY
MN
551292607
Practice Location Phone/Fax
| Phone: | 6514437265 |
| Fax: |
Provider Mailing Location
9806 GLACIAL VALLEY ALCOVE
WOODBURY
MN
551292607
Provider Mailing Phone/Fax
| Phone: | 6514437265 |
| Fax: |