Provider Demographics
NPI:1700078805
Name:KORANDA, DIANE LOIS (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LOIS
Last Name:KORANDA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 2ND ST
Mailing Address - Street 2:RM 510
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1404
Mailing Address - Country:US
Mailing Address - Phone:218-726-2995
Mailing Address - Fax:218-725-5186
Practice Address - Street 1:320 W 2ND ST
Practice Address - Street 2:RM 510
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1404
Practice Address - Country:US
Practice Address - Phone:218-726-2995
Practice Address - Fax:218-725-5186
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN85651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical