Healthcare Provider Details

I. General information

NPI: 1114804143
Provider Name (Legal Business Name): ELLYN RIDEOUT MSSA, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W BOWERY ST
AKRON OH
44308-1069
US

IV. Provider business mailing address

2705 TIFFT ST
CUYAHOGA FALLS OH
44221-2730
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8050
  • Fax:
Mailing address:
  • Phone: 419-356-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1200302
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: