Provider Demographics
NPI:1053955666
Name:DIANE DUNN, LLC
Entity type:Organization
Organization Name:DIANE DUNN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-820-1545
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-0291
Mailing Address - Country:US
Mailing Address - Phone:507-820-1545
Mailing Address - Fax:507-825-9978
Practice Address - Street 1:1029 3RD AVE STE 2
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2399
Practice Address - Country:US
Practice Address - Phone:507-820-1545
Practice Address - Fax:507-825-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health