Provider Demographics
NPI:1497416556
Name:TOLLEFSRUD, CLAIRE ELISE
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ELISE
Last Name:TOLLEFSRUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5736 W 25 1/2 ST
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1714
Mailing Address - Country:US
Mailing Address - Phone:612-599-7120
Mailing Address - Fax:
Practice Address - Street 1:501 4TH ST S STE 201
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-4754
Practice Address - Country:US
Practice Address - Phone:763-317-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health