Individual
SAMANTHA MICHELLE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
11097 SE 21ST AVE, MILWAUKIE, OR 97222-7640
(971) 401-0364
Mailing address
11097 SE 21ST AVE, MILWAUKIE, OR 97222-7640
(971) 401-0364
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
CG 60478731
WA
175T00000X
Peer Specialist
Primary
THW000002555
OR
Other
Enumeration date
03/22/2016
Last updated
12/07/2018
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