Kenneth J Ellis, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY00003392 Issued in WA

Practice address

1106 Columbia Ave
Suite 100
Marysville, WA 98270-4335

Phone

(360) 653-0374

Fax

(360) 658-0219

NPI assigned

Jul 15, 2006

Sex

Male

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

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455235200000",
    "number": "1417973850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 COLUMBIA AVE",
            "address_2": "SUITE 100",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982704335",
            "telephone_number": "360-653-0374",
            "fax_number": "360-658-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 COLUMBIA AVE",
            "address_2": "SUITE 100",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982704335",
            "telephone_number": "360-653-0374",
            "fax_number": "360-658-0219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2016-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00003392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ears 2 U Hearing Aid Services (Ears 2 U)
• Earthbody Massage and Spa
• Tina Marie Easley, CPC RC SUDPT
• Michael J Eberle
• Deandra T Elcock
• Hassan A Elmi
• Steffen Emard, LMP
• Endod Health Experts PLLC
• Engineered Sports 2 PLLC (Rober Hamre MBR)
• Daniel Thomas English Sr., DPT

• Clinical Psychologist in Marysville, WA
• Providers in Marysville, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.