Provider Demographics
NPI:1821743220
Name:INGRAM, ELLIE (MSW)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 S WYANDOT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-3322
Mailing Address - Country:US
Mailing Address - Phone:303-808-5176
Mailing Address - Fax:208-567-5844
Practice Address - Street 1:155 S MADISON ST STE 306
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3014
Practice Address - Country:US
Practice Address - Phone:866-285-2929
Practice Address - Fax:208-567-5844
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)