Healthcare Provider Details

I. General information

NPI: 1386620375
Provider Name (Legal Business Name): ELLA M. DUNCAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 EAGLE CTR STE B-1
O FALLON IL
62269-1946
US

IV. Provider business mailing address

7 EAGLE CTR STE B-1
O FALLON IL
62269-1946
US

V. Phone/Fax

Practice location:
  • Phone: 618-726-2041
  • Fax: 618-726-2043
Mailing address:
  • Phone: 618-581-2984
  • Fax: 618-256-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.011508
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: