Individual
DIANE DEBRA LEADERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
516 S POKEGAMA AVE, GRAND RAPIDS, MN 55744-3820
(218) 327-2001
Mailing address
516 S POKEGAMA AVE, GRAND RAPIDS, MN 55744-3820
(218) 327-2001
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
14409
MN
Other
Enumeration date
02/10/2022
Last updated
02/10/2022
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