Individual
SUSAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
W175N11163 STONEWOOD DR STE 106, GERMANTOWN, WI 53022-6501
(262) 345-4270
Mailing address
W175N11163 STONEWOOD DR STE 106, GERMANTOWN, WI 53022-6501
(262) 345-4270
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/29/2020
Last updated
01/31/2023
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