Provider Demographics
NPI:1538812839
Name:DIEM, JOANNA MARIE (LMFT)
Entity type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:MARIE
Last Name:DIEM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 XENIA AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1644
Mailing Address - Country:US
Mailing Address - Phone:763-213-5752
Mailing Address - Fax:
Practice Address - Street 1:4500 PARK GLEN RD STE 155
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4888
Practice Address - Country:US
Practice Address - Phone:612-405-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3846106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist