Provider Demographics
NPI:1346313616
Name:ZAESKE, ELLEN LOUISE (APRN, LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:LOUISE
Last Name:ZAESKE
Suffix:
Gender:F
Credentials:APRN, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 NODAK DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2366
Mailing Address - Country:US
Mailing Address - Phone:701-232-6224
Mailing Address - Fax:701-232-4687
Practice Address - Street 1:1112 NODAK DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2366
Practice Address - Country:US
Practice Address - Phone:701-232-6224
Practice Address - Fax:701-232-4687
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN69851041C0700X
MNR 124683-4364SP0808X
NDR20158364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN536527900Medicaid
MN536527900Medicaid
ND711713Medicare PIN