MEDICARE: ELIZABETH ANNE ELLIS LSWAIC

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
1	101Y00000X	Counselor	SC61363624	WA

General Provider Information

NPI Number	:	1790406718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE ELLIS LSWAIC

Provider Business Mailing Address
First Line	:	953 HODGIN ST APT 134
Second Line	:
City	:	SEDRO WOOLLEY
State	:	WA
Zip	:	98284-4313
Country	:	US
Telephone Number	:	817-789-2363
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 ROOSEVELT AVE
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-2687
Country	:	US
Telephone Number	:	360-939-1450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2022
Last Update Date	:	01/16/2026

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