Provider Demographics
NPI:1164457594
Name:DUNN, DIANE KAYE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:KAYE
Last Name:DUNN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:KAYE
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-0802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1234 OXFORD ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1760
Practice Address - Country:US
Practice Address - Phone:507-376-9758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN139811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12292632OtherCAQH
MN929697200Medicaid