Provider Demographics
NPI:1639396609
Name:ELLIS, CHRISTINE ELIZABETH (CSW-PIP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 S MINNESOTA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2707
Mailing Address - Country:US
Mailing Address - Phone:605-271-1348
Mailing Address - Fax:
Practice Address - Street 1:5000 S MINNESOTA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2707
Practice Address - Country:US
Practice Address - Phone:605-271-1348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1936104100000X
IA06783104100000X
MN18354104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker