Healthcare Provider Details

I. General information

NPI: 1134771710
Provider Name (Legal Business Name): JOHANNA KATHERINE CHEVRIER ELLIS LICSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOHANNA KATHERINE CHEVRIER

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 NE OAK VIEW DR
VANCOUVER WA
98662-6157
US

IV. Provider business mailing address

4701 NE 72ND AVE APT T205
VANCOUVER WA
98661-8182
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-2211
  • Fax:
Mailing address:
  • Phone: 909-380-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61572473
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: