Provider Demographics
NPI:1285334664
Name:ELLING PRZYBILLA, JUDITH ANN (LICSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:ELLING PRZYBILLA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 110TH ST
Mailing Address - Street 2:
Mailing Address - City:BALATON
Mailing Address - State:MN
Mailing Address - Zip Code:56115-3120
Mailing Address - Country:US
Mailing Address - Phone:952-288-7516
Mailing Address - Fax:
Practice Address - Street 1:916 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1890
Practice Address - Country:US
Practice Address - Phone:507-825-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical