Individual
LYLE GENE ELENKIWICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW
Contact information
Practice address
2311 146TH AVE NE, HAM LAKE, MN 55304-6408
(763) 242-9240
Mailing address
2311 146TH AVE NE, HAM LAKE, MN 55304-6408
(763) 242-9240
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11797
MN
Other
Enumeration date
08/08/2007
Last updated
08/08/2007
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