Basic Information
| Provider Information | |||||||||
| NPI: | 1447904016 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIELEN | ||||||||
| FirstName: | DIANNA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11901 88TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | DEER RIVER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566362750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2185661361 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2101 ELM ST N | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581022417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012393700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2022 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 10229 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.