MEDICARE: ELISE NELSON LICSW LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1790636785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELISE NELSON LICSW LLC

Provider Business Mailing Address
First Line	:	2045 DAVISON AVE
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99354-2014
Country	:	US
Telephone Number	:	509-551-0851
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 W HOOD PL STE 208
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-3400
Country	:	US
Telephone Number	:	509-551-0851
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	ELISE NELSON
Credential	:	LICSW
Telephone Number	:	509-551-0851

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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