Provider Demographics
NPI:1235349747
Name:ELLGEN, LYNAE R (LCSW)
Entity type:Individual
Prefix:
First Name:LYNAE
Middle Name:R
Last Name:ELLGEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 ALTA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-3225
Mailing Address - Country:US
Mailing Address - Phone:970-326-8138
Mailing Address - Fax:
Practice Address - Street 1:1040 ALTA VISTA DR
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625
Practice Address - Country:US
Practice Address - Phone:970-326-8138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW 177174400000X
COCSW.099235331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174400000XOther Service ProvidersSpecialist