Provider Demographics
NPI:1962387787
Name:ABDULLE, IDRIS
Entity type:Individual
Prefix:
First Name:IDRIS
Middle Name:
Last Name:ABDULLE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 146TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4655
Mailing Address - Country:US
Mailing Address - Phone:952-688-9365
Mailing Address - Fax:
Practice Address - Street 1:13944 EDGEWOOD AVE UNIT 212
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-1233
Practice Address - Country:US
Practice Address - Phone:952-688-9365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician