Provider Demographics
NPI:1497416556
Name:TOLLEFSRUD, CLAIRE ELISE
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ELISE
Last Name:TOLLEFSRUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9479 BANDY LN
Mailing Address - Street 2:
Mailing Address - City:SAINT BONIFACIUS
Mailing Address - State:MN
Mailing Address - Zip Code:55375-1357
Mailing Address - Country:US
Mailing Address - Phone:612-599-7120
Mailing Address - Fax:
Practice Address - Street 1:7770 DELL RD STE 120
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9316
Practice Address - Country:US
Practice Address - Phone:763-317-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional