Fardowsa Hassan Iman, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

305423 Issued in MN

Practice address

524 25TH Ave N
Saint Cloud, MN 56303-3255

Phone

(320) 202-1909

Fax

(320) 202-1910

NPI assigned

Apr 22, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Protea Health LLC

  • Addiction (Substance Use Disorder) Counselor
  • Saint Cloud, MN
  • NPI 1508613795
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558310400000",
    "number": "1730742172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 25TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563033255",
            "telephone_number": "320-202-1909",
            "fax_number": "320-202-1910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 25TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563033255",
            "telephone_number": "320-202-1909",
            "fax_number": "320-202-1910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMAN",
        "first_name": "FARDOWSA",
        "middle_name": "HASSAN",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-22",
        "last_updated": "2019-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fardowsa.iman@cmglp.com",
            "affiliation": "N",
            "address_1": "524 25th Ave N",
            "city": "Saint Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563033255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chibuzo Ikediego
• Kay Iken, CNP
• Samantha Illsley
• Imagine Nation LLC
• Bisharo Iman
• Farhiya Iman
• Muna Iman
• Aaron Daniel Imdieke, D.D.S.
• Robert Lukken Imel, DO
• Sydni Imel, DO

• Addiction (Substance Use Disorder) Counselor in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.