Healthcare Provider Details

I. General information

NPI: 1497802664
Provider Name (Legal Business Name): NANCY J. ELLIS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 E 137TH ST
KANSAS CITY MO
64145-1455
US

IV. Provider business mailing address

421 E 137TH ST
KANSAS CITY MO
64145-1455
US

V. Phone/Fax

Practice location:
  • Phone: 816-508-3600
  • Fax: 816-508-3797
Mailing address:
  • Phone: 816-508-3600
  • Fax: 816-508-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1420
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: