Healthcare Provider Details

I. General information

NPI: 1487091716
Provider Name (Legal Business Name): MISS WHITNEY ELIZABETH ENSOM-LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 W SHAW AVE STE 220
FRESNO CA
93711-3519
US

IV. Provider business mailing address

1690 W SHAW AVE STE 220
FRESNO CA
93711-3519
US

V. Phone/Fax

Practice location:
  • Phone: 559-908-0922
  • Fax:
Mailing address:
  • Phone: 559-908-0922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: