Provider Demographics
NPI:1851143747
Name:ELENWO, HESTHER
Entity Type:Individual
Prefix:
First Name:HESTHER
Middle Name:
Last Name:ELENWO
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 1:2233 UNIVERSITY AVE W STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1629
Mailing Address - Country:US
Mailing Address - Phone:720-519-9476
Mailing Address - Fax:
Practice Address - Street 1:2233 UNIVERSITY AVE W STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1629
Practice Address - Country:US
Practice Address - Phone:720-519-9476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health