Provider Demographics
NPI:1295361640
Name:ADICKES, ELAINA R
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:R
Last Name:ADICKES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ELAINA
Other - Middle Name:R
Other - Last Name:ADICKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10567 165TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-3523
Mailing Address - Country:US
Mailing Address - Phone:952-767-9374
Mailing Address - Fax:855-538-0663
Practice Address - Street 1:10567 165TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-3523
Practice Address - Country:US
Practice Address - Phone:952-767-9374
Practice Address - Fax:855-538-0663
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional