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NPI Code Detail

MEDICARE: JOAN M. ELLIS LCSW

MEDICARE:   JOAN M. ELLIS  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker000367MO

General Provider Information

NPI Number : 1750444196
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOAN M. ELLIS LCSW
Provider Business Mailing Address
First Line : 227 E MAIN ST
Second Line :
City : FESTUS
State : MO
Zip : 63028-1952
Country : US
Telephone Number : 636-931-2700
Fax Number : 636-931-2139
Provider Business Practice Location Address
First Line : 227 E MAIN ST
Second Line :
City : FESTUS
State : MO
Zip : 63028-1952
Country : US
Telephone Number : 636-931-2700
Fax Number : 636-931-2139
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 07/08/2007

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Directions to “ JOAN M. ELLIS LCSW” Practice Location

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