Ellickson, Jacklyn Mae

Ellickson, Jacklyn Mae is an individual health care provider with primary practice located at 401 Phalen Blvd , Saint Paul MN 55130-5302. She recently has only one registered license in Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism, which is considered as her primary health care specialty. Ellickson, Jacklyn Mae can be contacted via phone (651) 254-7870.

Contact Information

Primary practice address
401 Phalen Blvd Saint Paul MN 55130-5302
Phone: (651) 254-7870
Fax: (651) 254-7876
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X 62721-20 Wisconsin
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X 53921 Minnesota

Profile Details

NPI number 1538395496
LBN Legal business name Ellickson, Jacklyn Mae
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 5th, 2009
Last updated Mar 17th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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