Healthcare Provider Details

I. General information

NPI: 1477294262
Provider Name (Legal Business Name): ELLEN HONSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 1ST ST S STE 2B
WILLMAR MN
56201-4248
US

IV. Provider business mailing address

408 4TH AVE NE
MINNEAPOLIS MN
55413-2046
US

V. Phone/Fax

Practice location:
  • Phone: 612-643-0411
  • Fax: 612-484-5957
Mailing address:
  • Phone: 612-643-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP7099
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: