MEDICARE: STEPHANIE ANN DIETZ LISCW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	26354	MN

General Provider Information

NPI Number	:	1467083436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ANN DIETZ LISCW

Provider Business Mailing Address
First Line	:	333 WASHINGTON AVE N STE 500
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-1331
Country	:	US
Telephone Number	:	612-405-9337
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 WASHINGTON AVE N STE 500
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-1331
Country	:	US
Telephone Number	:	612-405-9337
Fax Number	:	651-925-0427

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	04/06/2026

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