Provider Demographics
NPI:1992378327
Name:ELLIOTT, EMILY (LSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ELLIOTT
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 1:7100 GRAPHICS WAY
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-1123
Mailing Address - Country:US
Mailing Address - Phone:740-428-0428
Mailing Address - Fax:740-909-4077
Practice Address - Street 1:715 S PLUM ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1631
Practice Address - Country:US
Practice Address - Phone:937-644-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.21064471041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical