Provider Demographics
NPI:1801103593
Name:KNUTSON, DIANNE MARIE (LADC)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:MARIE
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 BROADWAY SUITE 103
Mailing Address - Street 2:NEW VISIONS CENTER
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308
Mailing Address - Country:US
Mailing Address - Phone:320-763-0124
Mailing Address - Fax:320-763-0126
Practice Address - Street 1:1700 BROADWAY SUITE 3
Practice Address - Street 2:NEW VISIONS CENTER
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308
Practice Address - Country:US
Practice Address - Phone:320-763-0124
Practice Address - Fax:320-763-0126
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300645101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)