James Brayton Ellis
Individual provider Active NPI Social Worker · Kenton, OH
NPI 1013407113 · NPPES record last updated May 14, 2018
Key facts
- NPI
- 1013407113
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- S1701216 (OH)
- Practice address
- 775 E Eliza St
Kenton, OH 43326-1486 - Phone
- (419) 675-2243
- NPI assigned
- May 14, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S1701216 | OH | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker |
104100000X | S1701216 | OH | Yes |
Addresses
Primary practice location
775 E Eliza St
Kenton, OH 43326-1486
Mailing address
775 E Eliza St
Kenton, OH 43326-1486
Phone (419) 675-2243
Other providers in Kenton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.