Healthcare Provider Details

I. General information

NPI: 1386723161
Provider Name (Legal Business Name): DAVID HANRY DIPMAN PHD LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 UNIVERSITY AVE W SUITE N385
SAINT PAUL MN
55104-2801
US

IV. Provider business mailing address

1821 UNIVERSITY AVE W SUITE N385
SAINT PAUL MN
55104-2801
US

V. Phone/Fax

Practice location:
  • Phone: 651-644-8515
  • Fax: 651-644-3451
Mailing address:
  • Phone: 651-644-8515
  • Fax: 651-644-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4242
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberLP4242
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4242
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberLP4242
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: