Active NPI
Samantha Michelle Ellis, BA
- Peer Specialist
- Milwaukie, OR
National Provider Identifier
1841652567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- THW000002555
- Practice address
- 11097 SE 21St Ave
Milwaukie, OR 97222-7640 - Phone
- (971) 401-0364
- NPI assigned
- Mar 22, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | CG 60478731 | WA | |
| Peer Specialist | 175T00000X | THW000002555 | OR | Primary |
Addresses
Primary practice location
11097 SE 21St Ave
Milwaukie, OR 97222-7640
Mailing address
11097 SE 21St Ave
Milwaukie, OR 97222-7640
Phone (971) 401-0364
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG 60478731 | WA | MD | Social Worker |
| THW000002555 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544140800000",
"number": "1841652567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11097 SE 21ST AVE",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972227640",
"telephone_number": "971-401-0364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11097 SE 21ST AVE",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972227640",
"telephone_number": "971-401-0364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "SAMANTHA",
"middle_name": "MICHELLE",
"credential": "BA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-22",
"last_updated": "2018-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WA",
"license": "CG 60478731",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "THW000002555",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukie, OR
- Elite Care Oatfield Estates LLC (DBA Elite Care Jefferson-Ashland: Elite Care Adams-Hood; Elite Care Rainier-Helens)
- Elk Rock Wellness
- Lorena Belle Ellenberger, OTRL
- Ann Ellingwood, M.S., CF-SLP
- Todd James Elliott, PT
- Jaezpr Ellys
- Paul Elmore, MA, MS, LPC
- Rodel Capena Elpedes, PTA
- Justine Strach Elstad, CSWA
- Embodiment Evolution, LLC (Eric Van Leeuwen, LMT)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.