Organization
ANOKA PSYCHOLOGICAL SERVICES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNE M GORDON LICSW (CEO)
(763) 754-1531
Entity
Organization
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
103T00000X
Psychologist
3751
MN
103TB0200X
Cognitive & Behavioral Psychologist
3751
MN
103TC0700X
Clinical Psychologist
3751
MN
103TC1900X
Counseling Psychologist
3751
MN
103TC2200X
Clinical Child & Adolescent Psychologist
3751
MN
103TF0000X
Family Psychologist
3751
MN
1041C0700X
Clinical Social Worker
Primary
7835
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110367
HEALTH PARTNERS
—
01
—
401G6AN
BCBS
—
01
—
402G3AN
BCBS
—
Enumeration date
04/10/2007
Last updated
09/11/2025
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