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General NPI Number Information
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NPI Number | 1114751864
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Entity Type | Individual
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Provider Name | HALEY RENEE ELLIS MSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 08/27/2024
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 915 S RIVERSIDE DR NE
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City | MCCONNELSVILLE
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State | OH
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Zip | 43756-9102
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Country | US
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Telephone | 740-962-5204
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Fax | 740-962-3688
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Provider Business Mailing Address
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Address Line | 2845 BELL ST
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City | ZANESVILLE
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State | OH
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Zip | 43701-1720
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Country | US
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Telephone | 740-454-9766
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Fax | 740-588-6452
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2512038
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License Number State | OH
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