Bryan Ellingson, MSW, LICSW
Social Worker, Clinical in Saint Paul, MN. Individual provider (NPI-1).
NPI number1366041683
StatusActive
Last updated in NPPESNov 17, 2020
Details
- NPI
- 1366041683
- Entity type
- Individual (NPI-1)
- Name
- Bryan Ellingson
- Credential
- MSW, LICSW
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 19, 2020
- Certification date
- Oct 27, 2020
- Last updated
- Nov 17, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 26505 | MN | Yes |
Practice location
1821 University Ave W # 306aSaint Paul, MN 55104-2801
Phone 612-568-8670
Mailing address
1821 University Ave W # 306aSaint Paul, MN 55104-2801
Phone 612-568-8670
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