Provider Demographics
NPI:1336181346
Name:ELLIOTT, ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:ELLIOTT
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 1:1316 FREDERICA ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4801
Mailing Address - Country:US
Mailing Address - Phone:270-686-7999
Mailing Address - Fax:270-686-8092
Practice Address - Street 1:1316 FREDERICA ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4801
Practice Address - Country:US
Practice Address - Phone:270-686-7999
Practice Address - Fax:270-686-8092
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0026936Medicare PIN