Provider Demographics
NPI:1215459177
Name:REGINEK, ELLI M (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:ELLI
Middle Name:M
Last Name:REGINEK
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 10TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:RICE
Mailing Address - State:MN
Mailing Address - Zip Code:56367-4517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1406 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1900
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-656-7115
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN186771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical