Provider Demographics
NPI:1033530480
Name:ELLEGARD, LINDA (MA)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:ELLEGARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SPRINGDOWNS PLACE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906
Mailing Address - Country:US
Mailing Address - Phone:719-338-0849
Mailing Address - Fax:719-447-9482
Practice Address - Street 1:1465 KELLY JOHNSON BLVD
Practice Address - Street 2:STE 360
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-338-0849
Practice Address - Fax:719-447-9482
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor