Provider Demographics
NPI:1356972210
Name:CONHARTOSKI, ELLYN (LPC-IT)
Entity type:Individual
Prefix:
First Name:ELLYN
Middle Name:
Last Name:CONHARTOSKI
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7665 US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54847-4690
Mailing Address - Country:US
Mailing Address - Phone:715-372-5001
Mailing Address - Fax:
Practice Address - Street 1:7665 US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:WI
Practice Address - Zip Code:54847-4690
Practice Address - Country:US
Practice Address - Phone:715-372-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health