Ellingstad, Timothy P

Ellingstad, Timothy P is an individual health care provider with primary practice located at 190 Gardner Ave #3, Burlington WI 53105-2160. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Health, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is his primary health care specialty. Ellingstad, Timothy P can be contacted via phone (262) 763-7766.

Contact Information

Primary practice address
190 Gardner Ave #3 Burlington WI 53105-2160
Phone: (262) 763-7766
Fax: (262) 763-9326
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Health 103TH0004X
Behavioral Health & Social Service Providers / Psychologist 103T00000X 2452-057 Wisconsin

Profile Details

NPI number 1396851101
LBN Legal business name Ellingstad, Timothy P
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 22nd, 2006
Last updated Aug 23rd, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396851101 NPPES
Wisconsin MEDICAID 39142400

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