Individual
LISA MICHELLE ELLENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
420 E SARNIA ST, WINONA, MN 55987-6365
(507) 453-6226
Mailing address
368 W WABASHA ST, WINONA, MN 55987-5201
(507) 429-1967
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
30822
MN
1041C0700X
Clinical Social Worker
30822
MN
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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