Individual
MS. ELYSSA MARGARET BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
3395 PLYMOUTH ROAD, ST. DAVID'S CENTER, MINNETONKA, MN 55305-3765
(952) 939-0396
(952) 939-9266
Mailing address
3395 PLYMOUTH ROAD, MINNETONKA, MN 55305-3765
(952) 939-0396
(952) 939-9266
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
21294-LSW
MN
Other
Enumeration date
05/18/2012
Last updated
05/18/2012
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