Active NPI
Joanna Marie Diem, LMFT
- Marriage & Family Therapist
- St Louis Park, MN
National Provider Identifier
1538812839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 3846
- Practice address
- 4500 Park Glen Rd Ste 155
St Louis Park, MN 55416-4888 - Phone
- (612) 405-4057
- NPI assigned
- Jan 27, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 3846 | MN | Primary |
Addresses
Primary practice location
4500 Park Glen Rd Ste 155
St Louis Park, MN 55416-4888
Mailing address
4247 Xenia Ave N
Crystal, MN 55422-1644
Phone (763) 213-5752
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Sep 10, 2024 through Sep 10, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643241600000",
"number": "1538812839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4247 XENIA AVE N",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554221644",
"telephone_number": "763-213-5752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 PARK GLEN RD STE 155",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554164888",
"telephone_number": "612-405-4057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIEM",
"first_name": "JOANNA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-27",
"last_updated": "2022-01-27",
"certification_date": "2022-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "3846",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.