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NPI Code Detail

MEDICARE: EMILY M ELLIS LSW

MEDICARE: EMILY M ELLIS 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
1104100000XSocial Worker

General Provider Information

NPI Number : 1891219978
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY M ELLIS LSW
Provider Business Mailing Address
First Line : 908 E STROOP RD
Second Line :
City : KETTERING
State : OH
Zip : 45429-4634
Country : US
Telephone Number : 937-475-5228
Fax Number :
Provider Business Practice Location Address
First Line : 141 W 3RD ST
Second Line :
City : DAYTON
State : OH
Zip : 45402-1814
Country : US
Telephone Number : 937-461-5550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2017
Last Update Date : 07/14/2022

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