Provider Demographics
NPI:1992695241
Name:OSSMAN, SHOUKRIA TAHER
Entity type:Individual
Prefix:
First Name:SHOUKRIA
Middle Name:TAHER
Last Name:OSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14343 BROOKMERE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-4112
Mailing Address - Country:US
Mailing Address - Phone:218-329-0177
Mailing Address - Fax:
Practice Address - Street 1:1601 HIGHWAY 13 E STE 204
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6848
Practice Address - Country:US
Practice Address - Phone:952-209-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician