Healthcare Provider Details

I. General information

NPI: 1811946007
Provider Name (Legal Business Name): ELLEN JANICE CALVERT MS LP LICSW LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 ANDERSON AVE
ST CLOUD MN
56303
US

IV. Provider business mailing address

1406 6TH AVE N
ST CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-3761
  • Fax: 320-229-3763
Mailing address:
  • Phone: 320-251-2700
  • Fax: 320-656-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12154
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: