Provider Demographics
NPI:1447004106
Name:ELLIOTT, AARON (MSW, LGSW, LADC)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MSW, LGSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 CASCADE PLZ S
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1606
Mailing Address - Country:US
Mailing Address - Phone:507-250-5740
Mailing Address - Fax:
Practice Address - Street 1:5901 OMAHA AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6477
Practice Address - Country:US
Practice Address - Phone:952-999-7820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22852101YM0800X
MN305149101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health