Individual
MS. MARY ELLEN LINNIHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LP
Contact information
Practice address
516 S POKEGAMA AVE, SUITE B, GRAND RAPIDS, MN 55744-3800
(218) 244-9414
Mailing address
516 POKEGAMA AVENUE SOUTH, SUITE B, GRAND RAPIDS, MN 55744
(218) 244-9414
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3192
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
460844500
—
MN
01
—
9H399LI
BCBS PROVIDER #
MN
Enumeration date
10/03/2006
Last updated
07/09/2007
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