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General NPI Number Information
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NPI Number | 1962747923
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Entity Type | Individual
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Provider Name | ELLEN ANN CLEARY-PENNINGER MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 3208 50TH STREET CT STE 205A
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City | GIG HARBOR
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State | WA
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Zip | 98335-8486
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Country | US
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Telephone | 425-650-0101
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Fax | 425-650-0102
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Provider Business Mailing Address
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Address Line | 3208 50TH STREET CT STE 205A
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City | GIG HARBOR
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State | WA
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Zip | 98335-8486
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Country | US
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Telephone | 425-650-0101
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Fax | 425-650-0102
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60515895
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License Number State | WA
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