Ellie Covin, PSY.D, LP

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

LP 4519 Issued in MN

Practice address

1405 Lilac Dr N
Golden Valley, MN 55422-4535

Phone

(763) 545-7708

Fax

(763) 545-3479

NPI assigned

Jun 19, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Ellie Covin Wolpert Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154526069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17751 78TH PL N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553113770",
            "telephone_number": "763-494-4449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 LILAC DR N",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224535",
            "telephone_number": "763-545-7708",
            "fax_number": "763-545-3479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COVIN",
        "first_name": "ELLIE",
        "name_prefix": "Dr.",
        "credential": "PSY.D, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP 4519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELLIE",
            "last_name": "WOLPERT",
            "middle_name": "COVIN",
            "prefix": "DR.",
            "credential": "PSYD, LP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• All providers in Golden Valley, MN
• Clinical Child & Adolescent Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.