Ann Marie Dietman, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

30832 Issued in MN

Practice address

16123 Grant Utley Ave. NW
Cass Lake, MN 56633

Phone

(218) 335-3050

NPI assigned

Sep 11, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Leech Lake Band of Ojibwe

  • Federally Qualified Health Center (FQHC)
  • Cass Lake, MN
  • NPI 1275823742
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1083440564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7105 LITTLE WOLF RD NW",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "566333024",
            "telephone_number": "218-760-1976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16123 GRANT UTLEY AVE. NW",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "56633",
            "telephone_number": "218-335-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETMAN",
        "first_name": "ANN",
        "middle_name": "MARIE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-11",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "30832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Department of Human Services & PHS, IHS
• Department of Human Services &PHS, IHS
• Tamra Rae Devault
• Russell Devolder
• Whitney Dickson, PHARMD
• Diane Dietman, LPN
• Cynthia Ann Doke, RN
• Mark A Ellis, DDS
• Carolyn Erenberger, RN
• Pat Estey

• Clinical Social Worker in Cass Lake, MN
• Providers in Cass Lake, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.