MEDICARE: STEVEN LOUIS ELLENWOOD LMSW

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	6801058136	MI

General Provider Information

NPI Number	:	1871645655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN LOUIS ELLENWOOD LMSW

Provider Business Mailing Address
First Line	:	11920 EDEN TRL
Second Line	:
City	:	EAGLE
State	:	MI
Zip	:	48822-9621
Country	:	US
Telephone Number	:	517-930-0898
Fax Number	:

Provider Business Practice Location Address
First Line	:	11920 EDEN TRL
Second Line	:
City	:	EAGLE
State	:	MI
Zip	:	48822-9621
Country	:	US
Telephone Number	:	517-930-0898
Fax Number	:

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	03/18/2013

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