Provider Demographics
NPI:1043019334
Name:HASSAN, UMULKEYR
Entity type:Individual
Prefix:
First Name:UMULKEYR
Middle Name:
Last Name:HASSAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1055
Mailing Address - Country:US
Mailing Address - Phone:612-636-5139
Mailing Address - Fax:612-465-5056
Practice Address - Street 1:74 10TH AVE S
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1055
Practice Address - Country:US
Practice Address - Phone:612-636-5139
Practice Address - Fax:612-465-5056
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst