Healthcare Provider Details

I. General information

NPI: 1104740711
Provider Name (Legal Business Name): TAYLOR ELLSWORTH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 642303
PULLMAN WA
99164-2303
US

IV. Provider business mailing address

345 W MAIN ST UNIT B
PULLMAN WA
99163-2829
US

V. Phone/Fax

Practice location:
  • Phone: 509-335-3575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: