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NPI Code Detail

MEDICARE: ELLIE REMICK WHITEAKER

MEDICARE:   ELLIE REMICK WHITEAKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1851019145
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLIE REMICK WHITEAKER
Provider Business Mailing Address
First Line : 7601 WAYZATA BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55426-1623
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3601 MINNESOTA DR STE 575
Second Line :
City : EDINA
State : MN
Zip : 55435-5213
Country : US
Telephone Number : 612-223-8898
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2022
Last Update Date : 02/02/2024

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Directions to “ ELLIE REMICK WHITEAKER ” Practice Location

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