Provider Demographics
NPI:1831723808
Name:DEVELOPMENTAL DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:DEVELOPMENTAL DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:HIEB
Authorized Official - Last Name:CLAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:320-363-8055
Mailing Address - Street 1:15 E MINNESOTA ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-4691
Mailing Address - Country:US
Mailing Address - Phone:320-363-8055
Mailing Address - Fax:320-363-8056
Practice Address - Street 1:15 E MINNESOTA ST STE 105
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MN
Practice Address - Zip Code:56374-4691
Practice Address - Country:US
Practice Address - Phone:320-363-8055
Practice Address - Fax:320-363-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty