Individual
DIANE ATSIDAKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7615 GOLDEN TRIANGLE DR STE A, EDEN PRAIRIE, MN 55344-3733
(612) 400-6119
Mailing address
3527 KADY AVE NE, SAINT MICHAEL, MN 55376-3090
(612) 999-0969
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/22/2020
Last updated
08/11/2022
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