Annaliese Dianna Ellsworth, LCSW, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L7267 Issued in OR

Practice address

550 NW 3Rd Ave Ste Bandc
Canby, OR 97013

Phone

(503) 342-2510

Fax

(503) 406-2637

NPI assigned

Jul 9, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527120000000",
    "number": "1164838116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7100 SW HAMPTON ST STE 128&129",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238315",
            "telephone_number": "503-342-2510",
            "fax_number": "503-406-2637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 NW 3RD AVE STE BANDC",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "97013",
            "telephone_number": "503-342-2510",
            "fax_number": "503-406-2637"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14600 NW Cornell Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972295442",
            "country_code": "US",
            "telephone_number": "503-645-3581",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10424 SE Cherry Blossom Dr Ste Cd&e",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972162801",
            "country_code": "US",
            "telephone_number": "503-342-2510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "ANNALIESE",
        "middle_name": "DIANNA",
        "credential": "LCSW, MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-09",
        "last_updated": "2018-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L7267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lee Eaton-McNabb, MA, CADCI, LPC, ACS
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• Jonathan Eldredge
• Abigail D Ellis, RDH
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• Edelina Lanzon Espiritu, COTA
• John M Evans, RPH
• Lydia Evans
• Matthew Eveleigh, ATR-BC, LPC

• Clinical Social Worker in Canby, OR
• Providers in Canby, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.