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General NPI Number Information
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NPI Number | 1609939388
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Entity Type | Organization
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Legal Business Name | DIANE STELLRECHT & ASSOC INC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 570 ASHBURY ST SUITE 300
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City | ST PAUL
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State | MN
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Zip | 55104
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Country | US
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Telephone | 651-699-7050
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Fax | 651-699-8698
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Provider Business Mailing Address
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Address Line | 570 ASHBURY ST SUITE 300
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City | ST PAUL
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State | MN
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Zip | 55104
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Country | US
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Telephone | 651-699-7050
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Fax | 651-699-8698
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DIANE LOUISE STELLRECHT
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Credential | MS
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Telephone | 651-699-7050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1130
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License Number State | MN
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