1033379748 NPI number — MRS. ELENOR JOHNSON-ELLIS MSW LCSW

Table of content: MRS. ELENOR JOHNSON-ELLIS MSW LCSW (NPI 1033379748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033379748 NPI number — MRS. ELENOR JOHNSON-ELLIS MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON-ELLIS
Provider First Name:
ELENOR
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033379748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9201 WATERTOWN PLANK ROAD
Provider Second Line Business Mailing Address:
BEHAVIORAL HEALTH DIVISION SAIL
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53225-3558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-257-7405
Provider Business Mailing Address Fax Number:
414-454-4242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9201 WATERTOWN PLANK ROAD
Provider Second Line Business Practice Location Address:
BEHAVIORAL HEALTH DIVISION SAIL
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53225-3558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-257-7405
Provider Business Practice Location Address Fax Number:
414-454-4242
Provider Enumeration Date:
06/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1627123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10062926 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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