Individual
DR. GREGORY TIMOTHY ELLERMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3515 S 4TH ST, PROFESSIONAL ASSOCIATION, LEAVENWORTH, KS 66048
(913) 651-8415
(913) 772-8580
Mailing address
21 EAST 55TH ST, KANSAS CITY, MO 64113
(816) 333-3262
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
01582
MO
103T00000X
Psychologist
Primary
860
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004517
BCBS OF KANSAS GROUP
—
01
—
043080
BCBS OF KANSAS
KS
01
—
32816022
KANSAS CITY BCBS
KS
01
—
7030764
AETNA
—
Enumeration date
09/13/2006
Last updated
10/03/2008
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