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General NPI Number Information
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NPI Number | 1295546380
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Entity Type | Individual
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Provider Name | DIAMOND GOSA
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Gender | Female
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 110 1ST AVE NE
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City | NEW PRAGUE
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State | MN
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Zip | 56071-1824
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Country | US
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Telephone | 507-301-2846
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Fax |
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Provider Business Mailing Address
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Address Line | 3850 BALLANTRAE RD APT 8
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City | EAGAN
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State | MN
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Zip | 55122-1514
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Country | US
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Telephone | 708-791-8444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33966
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License Number State | MN
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