Healthcare Provider Details

I. General information

NPI: 1548182066
Provider Name (Legal Business Name): HAILEY ELLINGSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 32ND AVE S
FARGO ND
58103-5800
US

IV. Provider business mailing address

1001 NP AVE N APT 108
FARGO ND
58102-4880
US

V. Phone/Fax

Practice location:
  • Phone: 218-234-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1026
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: