Most Relevant Information
Provider Data
| NPI Number: | 1003549676 |
| Provider Name: | KHALEDA ISLAM |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/01/2022 |
| Last Updated: | 09/06/2022 |
Provider Practice Location
7615 GOLDEN TRIANGLE DR STE A
EDEN PRAIRIE
MN
553443733
Practice Location Phone/Fax
| Phone: | 6127677222 |
| Fax: |
Provider Mailing Location
17350 BAINBRIDGE DR
EDEN PRAIRIE
MN
553472295
Provider Mailing Phone/Fax
| Phone: | 6519556486 |
| Fax: |