Individual
MS. BONNIE KAY ELLINGBOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LP
Contact information
Practice address
14115 JAMES RD STE 305, ROGERS, MN 55374-9417
(763) 575-8086
(320) 774-0415
Mailing address
14115 JAMES RD STE 305, ROGERS, MN 55374-9417
(763) 575-8086
(320) 774-0415
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
MN3177
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
402820100
—
MN
01
—
6254698
MEDICARE UBH
MN
01
—
926S8EL
BCBS
MN
Enumeration date
11/01/2006
Last updated
05/17/2018
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