Pengelly, Earlyn Dorothy

Pengelly, Earlyn Dorothy is an individual health care provider with primary practice located at 430 Patterson Ave , Mankato MN 56001-2309. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Pengelly, Earlyn Dorothy can be contacted via phone (507) 388-5801.

Contact Information

Primary practice address
430 Patterson Ave Mankato MN 56001-2309
Phone: (507) 388-5801
Fax: (507) 388-2715
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X LP1114 Minnesota
Behavioral Health & Social Service Providers / Clinical 1041C0700X 4137 Minnesota

Profile Details

NPI number 1710004163
LBN Legal business name Pengelly, Earlyn Dorothy
Credentials M.A., M.S.
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 23rd, 2007
Last updated Jul 9th, 2007 - about 17 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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Identifiers

StateTypeNumberIssuer
All States NPI 1710004163 NPPES
Minnesota Other 57786PE BLUE CROSS BLUE SHIELD
Minnesota Other 120002 BLUE CROSS BLUE SHIELD
Minnesota Other 6120605 BLUE CROSS BLUE SHIELD
Minnesota Other HP28654 BLUE CROSS BLUE SHIELD

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