Individual
DR. DIANE LOUISE STELLRECHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LP
Contact information
Practice address
4027 COUNTY ROAD 25, MINNEAPOLIS, MN 55416-2629
(612) 925-6033
(612) 925-8496
Mailing address
4240 PARK GLEN RD, ST LOUIS PARK, MN 55416-5427
(612) 925-6033
(612) 925-8496
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
1130
MN
103TC0700X
Clinical Psychologist
1130
MN
103TC0700X
Clinical Psychologist
Primary
LP1130
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28682ST
BCBS
MN
05
—
588350400
—
MN
Enumeration date
08/06/2007
Last updated
12/22/2021
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