Provider Demographics
NPI:1558469353
Name:EHLERT, LAURA SULLIVAN (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:SULLIVAN
Last Name:EHLERT
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12940 HARRIET AVE S
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2680
Mailing Address - Country:US
Mailing Address - Phone:612-284-1557
Mailing Address - Fax:952-432-3826
Practice Address - Street 1:12940 HARRIET AVE S
Practice Address - Street 2:SUITE 250
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2680
Practice Address - Country:US
Practice Address - Phone:612-284-1557
Practice Address - Fax:952-432-3826
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 5415103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical