Active NPI
Ellie Marie Bungum
- Behavior Analyst
- Northfield, MN
National Provider Identifier
1952919672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- LBA0481
- Practice address
- 1403 Heritage Dr Ste a
Northfield, MN 55057-3227 - Phone
- (763) 200-4374
- NPI assigned
- Jul 20, 2020
- Last updated
- Aug 31, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | LBA0481 | MN | Primary |
Addresses
Primary practice location
1403 Heritage Dr Ste a
Northfield, MN 55057-3227
Mailing address
501 Madison Ave
Mankato, MN 56001
Phone (507) 682-7100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1070412988 | Other | MN | MEDICA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LBA0481 | MN | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788134400000",
"number": "1952919672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 MADISON AVE",
"city": "MANKATO",
"state": "MN",
"postal_code": "56001",
"telephone_number": "507-682-7100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1403 HERITAGE DR STE A",
"city": "NORTHFIELD",
"state": "MN",
"postal_code": "550573227",
"telephone_number": "763-200-4374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUNGUM",
"first_name": "ELLIE",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-20",
"last_updated": "2026-08-31",
"certification_date": "2026-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MN",
"license": "LBA0481",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "1070412988",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Northfield, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.