Healthcare Provider Details

I. General information

NPI: 1811459894
Provider Name (Legal Business Name): MORGAN JEANNE MCELLIGOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4635 NICOLS RD STE 100
EAGAN MN
55122-3410
US

IV. Provider business mailing address

313 WASHINGTON AVE S APT 1227
MINNEAPOLIS MN
55415-1467
US

V. Phone/Fax

Practice location:
  • Phone: 651-900-2210
  • Fax:
Mailing address:
  • Phone: 651-271-8608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0243
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: