Healthcare Provider Details

I. General information

NPI: 1285334664
Provider Name (Legal Business Name): JUDITH ANN ELLING PRZYBILLA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 4TH AVE SW
PIPESTONE MN
56164-1890
US

IV. Provider business mailing address

2257 110TH ST
BALATON MN
56115-3120
US

V. Phone/Fax

Practice location:
  • Phone: 507-825-7512
  • Fax:
Mailing address:
  • Phone: 952-288-7516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: