Provider Demographics
NPI:1891219978
Name:ELLIS, EMILY M (LSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 E STROOP RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4634
Mailing Address - Country:US
Mailing Address - Phone:937-475-5228
Mailing Address - Fax:
Practice Address - Street 1:141 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1814
Practice Address - Country:US
Practice Address - Phone:937-461-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker