Most Relevant Information
Provider Data
| NPI Number: | 1003506577 |
| Provider Name: | DIANA SUE SMITH LADC, MA |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/09/2023 |
| Last Updated: | 05/09/2023 |
Provider Practice Location
6800 78TH AVE N
BROOKLYN PARK
MN
554452758
Practice Location Phone/Fax
| Phone: | 6129243807 |
| Fax: |
Provider Mailing Location
6800 78TH AVE N
BROOKLYN PARK
MN
554452758
Provider Mailing Phone/Fax
| Phone: | 6129243807 |
| Fax: |