Marc R Ellison, LICSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SC60507250 Issued in WA

Practice address

414 Front St N
Issaquah, WA 98027-2914

Phone

(425) 392-6367

Fax

(425) 391-4971

NPI assigned

Oct 17, 2018

Last updated

Dec 5, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• M Eli Ellison Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Friends of Youth

  • Addiction (Substance Use Disorder) Counselor
  • Issaquah, WA
  • NPI 1144367350
  NPD (past)

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

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1891261855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 FRONT ST N",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272914",
            "telephone_number": "425-392-6367",
            "fax_number": "425-391-4971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 FRONT ST N",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272914",
            "telephone_number": "425-392-6367",
            "fax_number": "425-391-4971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "MARC",
        "middle_name": "R",
        "credential": "LICSWA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-17",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SC60507250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "M",
            "last_name": "ELLISON",
            "middle_name": "ELI",
            "credential": "LICSWA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Agatha Ekwam-Mensah
• Elizabeth Elander, PA-C
• Julie Ann Ellenberger, OTR/L
• Carrie Elliot, MA SLP
• Dana Elliott
• Emerald Blossom
• Jamie Emerson, ATC, MA-R
• Emily Tabor Counseling, PLLC
• Empowerme Rehabilitation Wa, PC
• Empowerme Rehabilitation, LLC

• Clinical Social Worker in Issaquah, WA
• Providers in Issaquah, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.