Provider Demographics
NPI:1669458923
Name:HARTSON, ELLEN (LISW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:HARTSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32915 AURORA RD,
Mailing Address - Street 2:#270
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139
Mailing Address - Country:US
Mailing Address - Phone:440-840-5619
Mailing Address - Fax:
Practice Address - Street 1:32915 AURORA RD
Practice Address - Street 2:#270
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3638
Practice Address - Country:US
Practice Address - Phone:440-840-5619
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI92391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical