Provider Demographics
NPI:1295752020
Name:PAPINEAU, ELLIE M (LAC)
Entity type:Individual
Prefix:MS
First Name:ELLIE
Middle Name:M
Last Name:PAPINEAU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:ELLIE
Other - Middle Name:M
Other - Last Name:RETTIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:300 13TH AVE W
Mailing Address - Street 2:STE 1
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4879
Mailing Address - Country:US
Mailing Address - Phone:701-227-7552
Mailing Address - Fax:701-227-7575
Practice Address - Street 1:300 13TH AVE W
Practice Address - Street 2:STE 1
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4879
Practice Address - Country:US
Practice Address - Phone:701-227-7552
Practice Address - Fax:701-227-7575
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1412101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND017335OtherBCBS PIN
ND54523Medicaid