Provider Demographics
NPI:1033395751
Name:OSBORNE, DANA MARIE (MA, LPCC, LICSW)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:MARIE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:MA, LPCC, LICSW
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:BARTLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 ELM AVE # 243
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-7706
Mailing Address - Country:US
Mailing Address - Phone:218-485-4445
Mailing Address - Fax:218-485-0477
Practice Address - Street 1:316 ELM AVE # 243
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767-7706
Practice Address - Country:US
Practice Address - Phone:218-727-5400
Practice Address - Fax:218-727-0077
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00359101YP2500X
MN232621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional