Individual
MRS. DIANE KAY BAUMBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
2755 10TH AVE N, GRAND FORKS, ND 58203
(701) 738-0888
(701) 757-1431
Mailing address
7055 148TH AVE NE, GRAFTON, ND 58237-9054
(218) 791-5669
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2971
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1456202
—
ND
Enumeration date
09/21/2006
Last updated
07/02/2019
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