Healthcare Provider Details

I. General information

NPI: 1366086290
Provider Name (Legal Business Name): ELLIOTT MANAGO-LAWLER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 PARKLAWN AVE STE 380
EDINA MN
55435-5156
US

IV. Provider business mailing address

7600 PARKLAWN AVE STE 380
EDINA MN
55435-5156
US

V. Phone/Fax

Practice location:
  • Phone: 612-203-2961
  • Fax: 952-831-0033
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number26467
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: