Gordon, Dianne M

Gordon, Dianne M is an individual health care provider with primary practice located at 11427 Hanson Blvd Nw , Coon Rapids MN 55433-3719. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Gordon, Dianne M can be contacted via phone (763) 754-1531.

Contact Information

Primary practice address
11427 Hanson Blvd Nw Coon Rapids MN 55433-3719
Phone: (763) 754-1531
Fax: (763) 754-3155
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 7835 Minnesota

Profile Details

NPI number 1154544096
LBN Legal business name Gordon, Dianne M
Credentials LICSW
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2007
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154544096 NPPES
Minnesota MEDICAID 00775155900
Minnesota Other 35976
Minnesota Other 401G6AN
Minnesota Other 6201201

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