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Contact Information

TIMOTHY P ELLINGSTAD, PHD
190 GARDNER AVE
#3
BURLINGTON, WI53105-2160
 Phone: 262-763-7766
 Fax: 262-763-9326
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
 

Health

103TH0004X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for TIMOTHY P ELLINGSTAD · (Male)

NPI # 1396851101
Status Active
Credentials PHD
Entity Individual
Enumeration date 08/22/2006
Last updated 08/23/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 2452-057
  • WI Medicaid 39142400
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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