MEDICARE: VICTORIA J ELLIS MSW, LSW

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	104100000X	Social Worker	S.1101357	OH

General Provider Information

NPI Number	:	1861351462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA J ELLIS MSW, LSW

Provider Business Mailing Address
First Line	:	6077 LEAFRIDGE LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-7721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	959 SAINT CLAIR AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3059
Country	:	US
Telephone Number	:	419-973-0368
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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