Provider Demographics
NPI:1245468032
Name:SCHOVILLE, ELLEN CHRISTINA
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:CHRISTINA
Last Name:SCHOVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:106 16TH STREET SOUTHWEST
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-0848
Mailing Address - Country:US
Mailing Address - Phone:319-352-2630
Mailing Address - Fax:319-352-0773
Practice Address - Street 1:106 16TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2822
Practice Address - Country:US
Practice Address - Phone:319-352-2630
Practice Address - Fax:319-352-0773
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000791501041C0700X
IA0071121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical