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General NPI Number Information
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NPI Number | 1154056455
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Entity Type | Individual
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Provider Name | ELLIE DARLINE STUMAN LSW
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Gender | Female
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 1200 2ND ST APT 8
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City | PEPIN
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State | WI
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Zip | 54759-3626
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Country | US
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Telephone | 651-247-6872
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Fax |
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Provider Business Mailing Address
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Address Line | 530 7TH AVE RM 501
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City | NEW YORK
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State | NY
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Zip | 10018-4850
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Country | US
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Telephone | 184-441-5459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 24977
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License Number State | MN
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