Healthcare Provider Details

I. General information

NPI: 1497416556
Provider Name (Legal Business Name): CLAIRE ELISE TOLLEFSRUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2021
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 DELL RD STE 120
CHANHASSEN MN
55317-9316
US

IV. Provider business mailing address

9479 BANDY LN
SAINT BONIFACIUS MN
55375-1357
US

V. Phone/Fax

Practice location:
  • Phone: 763-317-6203
  • Fax:
Mailing address:
  • Phone: 612-599-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: