Healthcare Provider Details

I. General information

NPI: 1639977333
Provider Name (Legal Business Name): LINDA M. ELLIS M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 COURT ST
SIOUX CITY IA
51101-1919
US

IV. Provider business mailing address

625 COURT ST
SIOUX CITY IA
51101-1919
US

V. Phone/Fax

Practice location:
  • Phone: 712-252-3871
  • Fax:
Mailing address:
  • Phone: 712-363-5743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number140248
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: