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General NPI Number Information
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NPI Number | 1316000797
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Entity Type | Individual
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Provider Name | ELAINE VIVIAN HUSELID M.ED
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 14579 GRAND AVE SUITE 200
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City | BURNSVILLE
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State | MN
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Zip | 55306-5702
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Country | US
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Telephone | 952-797-3169
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Fax | 952-426-1725
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Provider Business Mailing Address
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Address Line | 1641 W 140TH ST
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City | BURNSVILLE
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State | MN
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Zip | 55337-4418
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Country | US
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Telephone | 952-797-3169
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Fax | 952-426-1725
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 3047
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6542
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License Number State | MN
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