Provider Demographics
NPI:1285791384
Name:EHRMAN, VIRGINIA G (LP)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:G
Last Name:EHRMAN
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 SIBLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:DEEP HAVEN
Mailing Address - State:MN
Mailing Address - Zip Code:55391
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 WATER ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-1846
Practice Address - Country:US
Practice Address - Phone:612-701-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7445747OtherAENTA
MN62-42808OtherUBH
FM254L5EHOtherBLUE CROSS BLUE SHIELD