Provider Demographics
NPI:1356550693
Name:DIANE M SCHLAGEL
Entity type:Organization
Organization Name:DIANE M SCHLAGEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHLAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS , LP
Authorized Official - Phone:218-927-3417
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:218-927-3417
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:218-927-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1559103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN117273OtherUCARE
MN62-05540OtherMEDICA UBH
MN56432SCOtherBCBS
MN371752600Medicaid
MN117273OtherUCARE
MN62-05540OtherMEDICA UBH