Provider Demographics
NPI:1366229486
Name:COWKE, ABDIRASHIED LIBAN
Entity type:Individual
Prefix:
First Name:ABDIRASHIED
Middle Name:LIBAN
Last Name:COWKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 BRYANT AVE S APT 307
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2838
Mailing Address - Country:US
Mailing Address - Phone:612-297-4639
Mailing Address - Fax:
Practice Address - Street 1:1380 ENERGY LN STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5253
Practice Address - Country:US
Practice Address - Phone:763-346-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician