Individual
BRYAN ELLINGSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW
Contact information
Practice address
1821 UNIVERSITY AVE W # 306A, SAINT PAUL, MN 55104-2801
(612) 568-8670
Mailing address
1821 UNIVERSITY AVE W # 306A, SAINT PAUL, MN 55104-2801
(612) 568-8670
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
26505
MN
Other
Enumeration date
10/19/2020
Last updated
11/17/2020
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