Provider Demographics
NPI:1487716221
Name:DIAMOND, JANE SHELGREN (MSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:SHELGREN
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 HIGHWAY 36 W
Mailing Address - Street 2:302
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4063
Mailing Address - Country:US
Mailing Address - Phone:651-638-9396
Mailing Address - Fax:
Practice Address - Street 1:1620 HIGHWAY 36 W
Practice Address - Street 2:302
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4063
Practice Address - Country:US
Practice Address - Phone:651-638-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN - 006331041C0700X
BCD 0158321041C0700X
ICBMCPI - 19081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical