Provider Demographics
NPI:1972233047
Name:POCH, DIANA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:M
Last Name:POCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 220TH ST E
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:MN
Mailing Address - Zip Code:55031-9636
Mailing Address - Country:US
Mailing Address - Phone:192-086-0015
Mailing Address - Fax:
Practice Address - Street 1:3235 220TH ST E
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:MN
Practice Address - Zip Code:55031-9636
Practice Address - Country:US
Practice Address - Phone:192-086-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6260103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist