Healthcare Provider Details

I. General information

NPI: 1831723808
Provider Name (Legal Business Name): DEVELOPMENTAL DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E MINNESOTA ST STE 105
SAINT JOSEPH MN
56374-4691
US

IV. Provider business mailing address

15 E MINNESOTA ST STE 105
SAINT JOSEPH MN
56374-4691
US

V. Phone/Fax

Practice location:
  • Phone: 320-363-8055
  • Fax: 320-363-8056
Mailing address:
  • Phone: 320-363-8055
  • Fax: 320-363-8056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HOLLY HIEB CLAUSEN
Title or Position: OWNER
Credential: PH.D.
Phone: 320-363-8055