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General NPI Number Information
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NPI Number | 1801379060
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Entity Type | Individual
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Provider Name | MICHELLE DINEEN LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 8640 EAGLE CREEK CIR
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City | SAVAGE
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State | MN
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Zip | 55378-4400
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Country | US
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Telephone | 952-746-7664
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Fax | 952-224-4867
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Provider Business Mailing Address
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Address Line | 13618 UPTON AVE S
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City | BURNSVILLE
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State | MN
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Zip | 55337-2129
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Country | US
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Telephone | 612-816-4204
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 18603
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License Number State | MN
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