Provider Demographics
NPI:1760483531
Name:FINCH, ELLEN S (PSYD, LISW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:S
Last Name:FINCH
Suffix:
Gender:F
Credentials:PSYD, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 S. DIXIE DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439
Mailing Address - Country:US
Mailing Address - Phone:937-299-0636
Mailing Address - Fax:937-294-4669
Practice Address - Street 1:3131 S. DIXIE DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439
Practice Address - Country:US
Practice Address - Phone:937-299-0636
Practice Address - Fax:937-294-4669
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S98350Medicare UPIN
OHFISW21593Medicare ID - Type Unspecified