Individual
DIANE RAE GRINNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
3450 OLEARY LN, EAGAN, MN 55123-2340
(651) 454-0114
(651) 454-3492
Mailing address
12773 ETHELTON WAY, APPLE VALLEY, MN 55124-7802
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8942
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018757700
MN CARE
MN
01
—
123136
UCARE
FM
01
—
41-1546550
BHP
MN
01
—
60F01GR
BCBS
MN
01
—
62-60394
UBH
MN
01
—
HP17977
HEALTHPARTNERS
MN
Enumeration date
10/05/2006
Last updated
03/21/2018
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