Provider Demographics
NPI:1134378565
Name:ELLWOOD, JENNIFER CHARLOTTE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHARLOTTE
Last Name:ELLWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 KINGSWOOD RD W
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-4690
Mailing Address - Country:US
Mailing Address - Phone:765-714-9042
Mailing Address - Fax:
Practice Address - Street 1:100 SAW MILL RD
Practice Address - Street 2:3200
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5592
Practice Address - Country:US
Practice Address - Phone:765-742-4848
Practice Address - Fax:765-477-9905
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3400529A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical