Individual
ELLIE MARIE BUNGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
501 MADISON AVE, MANKATO, MN 56001
(507) 682-7100
Mailing address
501 MADISON AVE, MANKATO, MN 56001
(507) 682-7100
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LBA0481
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1070412988
MEDICA
MN
Enumeration date
07/20/2020
Last updated
07/28/2025
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