Individual
EMILY GRACE ELLSWORTH I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1400 W GREENLEAF AVE, CHICAGO, IL 60626-2805
(312) 806-9627
Mailing address
2236 W LOGAN BLVD APT 2, CHICAGO, IL 60647-2115
(928) 242-4367
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.025332
IL
Other
Enumeration date
08/11/2023
Last updated
08/11/2023
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