Individual
DIANE E PAGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LP
Contact information
Practice address
540 E 1ST ST, WACONIA, MN 55387-1600
(952) 442-4437
(952) 442-3084
Mailing address
540 E 1ST ST, WACONIA, MN 55387-1600
(952) 442-4437
(952) 442-3084
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP1611
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
712753700
—
MN
Enumeration date
08/10/2006
Last updated
09/05/2019
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