Provider Information for 1053910497
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Ms. ELLEN MINTER LCSW
Sex: Female
NPI: 1053910497
Last Updated: 2023-02-07
Certification Date: 2020-10-21
Certification Date: 2020-10-21
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1053910497 | ||||||||
| Enumeration Date | 2020-10-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 8101 POLO CLUB DR STE 6 MERRILLVILLE, IN 46410-5870 United States Phone: 219-810-5372 | Fax: | ||||||||
| Primary Practice Address | 7108 BROADWAY APT 1A MERRILLVILLE, IN 46410-3469 United States Phone: 219-810-5372 | Fax: | ||||||||
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