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Individual

MS. DIANE MARIE FOY KUNTZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MED LP

Contact information

Practice address
100 SOUTH FULLER STREET, SUITE 140, SHAKOPEE, MN 55379
(612) 644-8824
(952) 447-4907
Mailing address
100 SOUTH FULLER STREET, SUITE 140, SHAKOPEE, MN 55379
(612) 644-8824
(952) 447-4907

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3144
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
064K7F0
BLUE CROSS BLUE SHIELD
MN
Enumeration date
10/05/2006
Last updated
07/08/2007
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