Provider Demographics
NPI:1134771710
Name:CHEVRIER ELLIS, JOHANNA KATHERINE (LICSW, MSW)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:KATHERINE
Last Name:CHEVRIER ELLIS
Suffix:
Gender:F
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:KATHERINE
Other - Last Name:CHEVRIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4701 NE 72ND AVE APT T205
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-8182
Mailing Address - Country:US
Mailing Address - Phone:909-380-4127
Mailing Address - Fax:
Practice Address - Street 1:9300 NE OAK VIEW DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6157
Practice Address - Country:US
Practice Address - Phone:360-567-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 175T00000X
WALW615724731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No175T00000XOther Service ProvidersPeer Specialist