Provider Demographics
NPI:1427243005
Name:ELLEN S. TEIGLAND, L.P.,P.A.
Entity type:Organization
Organization Name:ELLEN S. TEIGLAND, L.P.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:TEIGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LP,PA
Authorized Official - Phone:218-326-7089
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-0794
Mailing Address - Country:US
Mailing Address - Phone:218-326-7089
Mailing Address - Fax:218-326-4714
Practice Address - Street 1:520 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2619
Practice Address - Country:US
Practice Address - Phone:218-326-7089
Practice Address - Fax:218-326-4714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2283103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN69711TEOtherBLUE CROSS OF MINNESOTA
R05184Medicare UPIN
MN89000012Medicare PIN