Provider Demographics
NPI:1437157278
Name:LINDBERG, DIANNE E (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:E
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:E
Other - Last Name:ISAACSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 4TH AVE W
Mailing Address - Street 2:GOVERNMENT CENTER RM 300
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1220
Mailing Address - Country:US
Mailing Address - Phone:952-496-8481
Mailing Address - Fax:
Practice Address - Street 1:200 4TH AVE W
Practice Address - Street 2:GOVERNMENT CENTER RM 300
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1220
Practice Address - Country:US
Practice Address - Phone:952-496-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN930017100Medicaid
MN800001326Medicare ID - Type Unspecified