Individual
DIANNE M GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
11427 HANSON BLVD NW, COON RAPIDS, MN 55433-3719
(763) 754-1531
(763) 754-3155
Mailing address
11427 HANSON BLVD NW, COON RAPIDS, MN 55433-3719
(763) 754-1531
(763) 754-3155
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7835
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00775155900
—
MN
01
—
35976
HEALTH PARTNERS
MN
01
—
401G6AN
BCBS
MN
01
—
6201201
MEDICA UBH
MN
Enumeration date
04/10/2007
Last updated
07/08/2007
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