Provider Demographics
NPI:1366454068
Name:SCHLAGEL, DIANE (MSLP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SCHLAGEL
Suffix:
Gender:F
Credentials:MSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29746 394TH PL
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-4446
Mailing Address - Country:US
Mailing Address - Phone:218-927-3417
Mailing Address - Fax:
Practice Address - Street 1:29746 394TH PL
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-4446
Practice Address - Country:US
Practice Address - Phone:218-927-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1559103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01012789OtherPREFERRED ONE
MN1C149SCOtherBCBS
MN117273OtherUCARE
MN62-05540OtherMEDICA