Provider Demographics
NPI:1427039106
Name:SAUL, ELLEN HODGES (LP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:HODGES
Last Name:SAUL
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14781 BAGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-7327
Mailing Address - Country:US
Mailing Address - Phone:507-334-9117
Mailing Address - Fax:507-334-9127
Practice Address - Street 1:14781 BAGLEY AVE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-7327
Practice Address - Country:US
Practice Address - Phone:507-334-9117
Practice Address - Fax:507-334-9127
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1614103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111769OtherBHP
MN600974OtherMMSI
MN932053900Medicaid
MN099J55AOtherBC/BS
MN099J55AOtherBC/BS