MEDICARE: MOLLY GENE DIETZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1518822311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY GENE DIETZ

Provider Business Mailing Address
First Line	:	5868 BAKER RD
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345
Country	:	US
Telephone Number	:	952-767-4200
Fax Number	:	952-767-4211

Provider Business Practice Location Address
First Line	:	2101 ROLLING GREEN LANE
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003
Country	:	US
Telephone Number	:	952-767-4200
Fax Number	:	952-767-4211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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Directions to “ MOLLY GENE DIETZ ” Practice Location

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