Provider Demographics
NPI:1811459894
Name:MCELLIGOTT, MORGAN JEANNE
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:JEANNE
Last Name:MCELLIGOTT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WASHINGTON AVE S APT 1227
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1467
Mailing Address - Country:US
Mailing Address - Phone:651-271-8608
Mailing Address - Fax:
Practice Address - Street 1:4635 NICOLS RD STE 100
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3410
Practice Address - Country:US
Practice Address - Phone:651-900-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician