Michelle Marie Ely, LCSW
Individual provider Active NPI Clinical Social Worker · Eielson Afb, AK
NPI 1366980260 · NPPES record last updated Jun 13, 2024
Key facts
- NPI
- 1366980260
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 165433 (AK)
- Practice address
- 2630 Central Ave
Eielson Afb, AK 99702-2301 - Phone
- (907) 377-4041
- NPI assigned
- Feb 10, 2017
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 165433 | AK | MD | Clinical Social Worker |
| LCSW86978 | CA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW86978 | CA | |
| Clinical Social Worker | 1041C0700X | 165433 | AK | Yes |
Addresses
Primary practice location
2630 Central Ave
Eielson Afb, AK 99702-2301
Mailing address
2630 Central Ave
Eielson Afb, AK 99702-2301
Phone (907) 377-4041
Other providers in Eielson Afb, AK
- Jamie Yvonne Custodio
- Tara Marie Dillow
- Alton E Doe Jr.
- Brad T Driscoll
- Holly Vokoun Ellenberger
- Ashley Noelle Franz
- Kathleen Frost
- Peter Fullmer
- Matthew Gray
- Brendan James Hall
All providers in Eielson Afb, AK · Clinical Social Worker in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2024. 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.