Provider Demographics
NPI:1649940115
Name:DIEFENBACH, TRACY M (PHD MRMS CCTP)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:M
Last Name:DIEFENBACH
Suffix:
Gender:F
Credentials:PHD MRMS CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-1519
Mailing Address - Country:US
Mailing Address - Phone:218-637-0399
Mailing Address - Fax:
Practice Address - Street 1:816 2ND ST NE
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1519
Practice Address - Country:US
Practice Address - Phone:218-637-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study