Individual provider Active NPI

Valerie Shae Ellington, LCSW

  • Clinical Social Worker
  • Champaign, IL
National Provider Identifier
1629130505
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
202 W Park Ave
Champaign, IL 61820-3929
Phone
(217) 373-2428
Fax
(217) 373-2445
NPI assigned
Dec 15, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X IL
Clinical Social Worker 1041C0700X IL Primary

Addresses

Primary practice location

202 W Park Ave
Champaign, IL 61820-3929

Mailing address

1620 W Park Ave
Champaign, IL 61821-3043
Phone (217) 352-1851

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20100220000405 IL Practitioner - Clinical Social Worker 7416091046

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
150.010560ILMDSocial Worker
149012511ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Promise Healthcare NFP CurrentSince Mar 9, 2016 Accepting new patients
Shae Ellington Counseling Clinical Current Accepting new patients
Promise Healthcare NFP CurrentSince Mar 9, 2016 Accepting new patients

Locations

819 Bloomington Rd
Champaign, IL 61820
Phone (217) 356-1558

Interoperability endpoints

  • Direct secure messaging: valerieshae.ellington.p11@direct.fhn-fqhc.nextgenshare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1629130505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 W PARK AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618213043",
            "telephone_number": "217-352-1851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 W PARK AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203929",
            "telephone_number": "217-373-2428",
            "fax_number": "217-373-2445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGTON",
        "first_name": "VALERIE",
        "middle_name": "SHAE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-15",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.