Diane Kay Felton, PHD, LP

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

LP1489 Issued in MN

Practice address

11165 Zealand Ave N
Champlin, MN 55316-3595

Phone

(763) 531-0566

Fax

(763) 531-0602

NPI assigned

Nov 13, 2006

Last updated

Feb 13, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 5

Other names 1

• Diane Kay Sandrum Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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

• North Therapy and Wellness PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Champlin, MN
  • NPI 1265462212
  NPD

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1235200791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11165 ZEALAND AVE N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553163595",
            "telephone_number": "763-531-0566",
            "fax_number": "763-531-0602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11165 ZEALAND AVE N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553163595",
            "telephone_number": "763-531-0566",
            "fax_number": "763-531-0602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELTON",
        "first_name": "DIANE",
        "middle_name": "KAY",
        "name_prefix": "Dr.",
        "credential": "PHD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP1489",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP1489",
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "MN",
            "license": "LP1489",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "MN",
            "license": "LP1489",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "104655",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "193852500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP35175",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "4H026FE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "61-12600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "SANDRUM",
            "middle_name": "KAY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brian S Falbo, R.PH.
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• Suhayb Abdi Farah
• Ellen Fastner, NP
• Pamela Fleagle, MA
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• Olitha Jamesetta Fofana, AGPCNP-BC
• Kenneth Fox

• Clinical Child & Adolescent Psychologist in Champlin, MN
• Providers in Champlin, MN by specialty
• Clinical Child & Adolescent Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; 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.