Provider Demographics
NPI:1093476343
Name:MEHR, ELLIE (MT-BC)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:
Last Name:MEHR
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4319 BRYANT AVE S # C102
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1760
Mailing Address - Country:US
Mailing Address - Phone:612-876-6563
Mailing Address - Fax:
Practice Address - Street 1:17645 JUNIPER PATH STE 205
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-7491
Practice Address - Country:US
Practice Address - Phone:612-876-6563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist