Healthcare Provider Details

I. General information

NPI: 1053805085
Provider Name (Legal Business Name): ELYSE MICHELLE DOWDY CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MAYFAIR DR STE 409
OWENSBORO KY
42301-4570
US

IV. Provider business mailing address

2211 MAYFAIR DR STE 409
OWENSBORO KY
42301-4570
US

V. Phone/Fax

Practice location:
  • Phone: 618-242-6944
  • Fax:
Mailing address:
  • Phone: 270-417-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number258308
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number259516
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: