Individual
DR. TIMOTHY P ELLINGSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
190 GARDNER AVE, #3, BURLINGTON, WI 53105-2160
(262) 763-7766
(262) 763-9326
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 647-6326
(414) 671-8860
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2452-057
WI
103TH0004X
Health Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39142400
—
WI
Enumeration date
08/22/2006
Last updated
08/23/2019
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