Individual
DIANE JASKOVIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
3100 W LAKE ST, SUITE 210, MINNEAPOLIS, MN 55416-4527
(612) 925-6033
(612) 925-8496
Mailing address
3100 W LAKE ST, SUITE 210, MINNEAPOLIS, MN 55416-4527
(612) 925-6033
(612) 925-8496
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2937
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141K9JA
BCBS
MN
01
—
6274495
MEDICA CHOICE
MN
01
—
HP27266
HEALTHPARTNERS
MN
Enumeration date
11/28/2006
Last updated
07/08/2007
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