Provider Demographics
NPI:1922046481
Name:ACKARD, DIANN M (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANN
Middle Name:M
Last Name:ACKARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 OLSON MEMORIAL HWY
Mailing Address - Street 2:#4001
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5149
Mailing Address - Country:US
Mailing Address - Phone:763-595-7294
Mailing Address - Fax:763-595-7293
Practice Address - Street 1:5101 OLSON MEMORIAL HWY
Practice Address - Street 2:#4001
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-5149
Practice Address - Country:US
Practice Address - Phone:763-595-7294
Practice Address - Fax:763-595-7293
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4200103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN202354-53OtherEMPLOYEE IDENTIFICATION N