Individual
CONNIE L. DITTRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LP
Contact information
Practice address
6542 REGENCY LN, #209, EDEN PRAIRIE, MN 55344-7847
(952) 903-9250
Mailing address
6542 REGENCY LANE, #209, EDEN PRAIRIE, MN 55344
(952) 903-9250
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
LP3987
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42G91DI
BCBS CLINIC NUMBER
MN
01
—
42G92DI
PROVIDER PIN
MN
Enumeration date
04/20/2007
Last updated
07/08/2007
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