MEDICARE: ELLIE MCMANN LCSW LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1134820731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLIE MCMANN LCSW LLC

Provider Business Mailing Address
First Line	:	17 2ND ST E STE 203
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-4500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 2ND ST E STE 203
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-4500
Country	:	US
Telephone Number	:	406-290-9946
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH MCMANN
Credential	:	LCSW
Telephone Number	:	406-290-9946

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	03/13/2023

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