MEDICARE: JENNIFER ELLIS

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	104100000X	Social Worker
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1952577603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ELLIS

Provider Business Mailing Address
First Line	:	8082 VETERANS PKWY APT 4604
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-4956
Country	:	US
Telephone Number	:	706-566-4344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 13TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2246
Country	:	US
Telephone Number	:	706-780-1704
Fax Number	:

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

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	04/06/2021

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Directions to “ JENNIFER ELLIS ” Practice Location

Language	Start Address	Practice Location

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