| Doctor Name: | ELLEN J PELLETIER |
| NPI Number: | 1093764854 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA LP LICSW |
| License Number: | 12925 |
| Business Practice Address: | 713 Anderson Ave St Cloud, MN - 56303 |
| Business Phone Number: | 3202293761 |
| Business Fax Number: | 3202293763 |
| Mailing Address: | 1406 6th Ave N, ST CLOUD |
| State: | MN |
| Postal Code: | 56303 |
| Phone Number: | 3202512700 |
| Fax Number: | 3206567026 |
| NPI Enumeration Date: | 05/09/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 12925 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |