Bryan Ellingson, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

26505 Issued in MN

Practice address

1821 University Ave W # 306a
Saint Paul, MN 55104-2801

Phone

(612) 568-8670

NPI assigned

Oct 19, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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": "1603065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1366041683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 UNIVERSITY AVE W # 306A",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551042801",
            "telephone_number": "612-568-8670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 UNIVERSITY AVE W # 306A",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551042801",
            "telephone_number": "612-568-8670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSON",
        "first_name": "BRYAN",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-19",
        "last_updated": "2020-11-17",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "26505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael A Ellerman, DO
• Megan Ellerson, DNP, APRN, WHNP-BC
• Emmy Rose Ellestad, CRNA
• Jacklyn Mae Ellickson, MD
• Ellie Ott L.L.C.
• Eric Ellingson, M.D.
• Lucy Sophia Ellingson
• Megan Kathleen Ellingson, CHW
• Taylor Leigh Ellingson, PT
• Sarah Beth Elliott, OTR/L

• Clinical Social Worker in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.