Provider Demographics
NPI:1073160776
Name:ELLMANN, REBECCA JANE (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:ELLMANN
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6636 CEDAR AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2705
Mailing Address - Country:US
Mailing Address - Phone:612-512-1085
Mailing Address - Fax:612-268-5858
Practice Address - Street 1:6636 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2705
Practice Address - Country:US
Practice Address - Phone:612-512-1085
Practice Address - Fax:612-268-5858
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional