Individual
TRACI ELLERSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
15285 WATERTOWN PLANK RD, ELM GROVE, WI 53122-2339
(262) 797-2818
(262) 797-2814
Mailing address
7330 W LAYTON AVE, MILWAUKEE, WI 53220-3849
(414) 817-8896
(414) 817-8940
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1964-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39725300
—
WI
Enumeration date
10/01/2008
Last updated
10/01/2008
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