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General NPI Number Information
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NPI Number | 1538812839
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Entity Type | Individual
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Provider Name | JOANNA MARIE DIEM LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 4500 PARK GLEN RD STE 155
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-4888
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Country | US
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Telephone | 612-405-4057
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Fax |
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Provider Business Mailing Address
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Address Line | 4247 XENIA AVE N
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City | CRYSTAL
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State | MN
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Zip | 55422-1644
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Country | US
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Telephone | 763-213-5752
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3846
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License Number State | MN
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