Provider Demographics
NPI:1932476884
Name:PLUMMER, ELLEN (LMSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:BAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 DIANA ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1987
Mailing Address - Country:US
Mailing Address - Phone:231-845-6264
Mailing Address - Fax:231-845-7095
Practice Address - Street 1:920 DIANA ST
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1987
Practice Address - Country:US
Practice Address - Phone:231-845-6264
Practice Address - Fax:231-845-7095
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL19959451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical