Provider Demographics
NPI:1134442023
Name:ELLIS, JAMES N (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:N
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6829 COUNTY HIGHWAY A
Mailing Address - Street 2:
Mailing Address - City:ADELL
Mailing Address - State:WI
Mailing Address - Zip Code:53001-1538
Mailing Address - Country:US
Mailing Address - Phone:920-207-3801
Mailing Address - Fax:
Practice Address - Street 1:101C N MILL ST
Practice Address - Street 2:
Practice Address - City:SAUKVILLE
Practice Address - State:WI
Practice Address - Zip Code:53080-1921
Practice Address - Country:US
Practice Address - Phone:920-207-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1993-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical