Healthcare Provider Details

I. General information

NPI: 1730810714
Provider Name (Legal Business Name): ELLIE HOFSTEDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/23/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 1ST AVE NE
MINNEAPOLIS MN
55413-2447
US

IV. Provider business mailing address

615 1ST AVE NE
MINNEAPOLIS MN
55413-2447
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-2300
  • Fax:
Mailing address:
  • Phone: 952-693-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28363
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: