Provider Demographics
NPI:1740744853
Name:FELLERSEN, EVE-LYNN R
Entity Type:Individual
Prefix:
First Name:EVE-LYNN
Middle Name:R
Last Name:FELLERSEN
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 1:104 W SUPERIOR ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-3000
Mailing Address - Country:US
Mailing Address - Phone:218-727-7353
Mailing Address - Fax:218-727-2646
Practice Address - Street 1:104 W SUPERIOR ST STE 200
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-3000
Practice Address - Country:US
Practice Address - Phone:218-727-7353
Practice Address - Fax:218-727-2646
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health