SAMANTHA MICHELLE ELLIS (NPI# 1841652567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841652567 |
| Entity Type | Individual |
| Full Name | SAMANTHA MICHELLE ELLIS |
| Credential | BA |
| Practice Address |
11097 Se 21st Ave Milwaukie OR 97222-7640 |
| Practice Telephone | 9714010364 |
| Mailing Telephone | 9714010364 |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2018-12-07 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 104100000X | Social Worker | CG 60478731 | WA | Behavioral Health & Social Service Providers |
| Y | 175T00000X | Peer Specialist | THW000002555 | OR | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174918098 | Samantha Rose Ellis | Dermatology | 600 San Ramon Valley Blvd Ste 102, Danville, CA 94526-4021 | 2015-03-30 |
| 1811417736 | Samantha Ellis | Behavior Technician | 41521 W 11 Mile Rd, Novi, MI 48375 | 2017-06-21 |
| 1356799985 | Samantha Ellis | Nurse Practitioner | 15420 N 32nd Dr, Phoenix, AZ 85053 | 2016-05-24 |
| 1710341391 | Samantha Ellis | Nutritionist | 8915 Sw Center St, Tigard, OR 97223-6307 | 2016-04-08 |
| 1861861429 | Samantha Ellis | Counselor | 487 Center St, Manchester, CT 06040-3982 | 2015-09-24 |
| 1578962437 | Samantha A Ellis | Pharmacist | 320 Park Ave, Worcester, MA 01610-1021 | 2014-08-17 |
| 1285044750 | Samantha Ellis | Dietitian, Registered | 44 Pleasant Ave, Walden, NY 12586-1240 | 2014-05-05 |
| 1164726063 | Samantha Lee Ellis | Registered Nurse | 6200 Sw 73rd St, South Miami, FL 33143-4679 | 2011-01-06 |
| Street Address |
11097 SE 21ST AVE |
| City | MILWAUKIE |
| State | OR |
| Zip Code | 97222-7640 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407358799 | Solmaira Trujillo | Peer Specialist | 11097 Se 21st Ave, Milwaukie, OR 97222-7640 | 2018-03-02 |
| 1831691039 | Caitlin Ruderman | Contractor | 11097 Se 21st Ave, Milwaukie, OR 97222-7640 | 2018-03-02 |
| 1578065868 | Darrin Hernandez | Peer Specialist | 11097 Se 21st Ave, Milwaukie, OR 97222-7640 | 2018-03-02 |
| 1366963860 | Lauren Conn | Peer Specialist | 11097 Se 21st Ave, Milwaukie, OR 97222-7640 | 2017-07-05 |
| 1245751890 | Amanda Willard | Peer Specialist | 11097 Se 21st Ave, Milwaukie, OR 97222-7640 | 2017-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831731397 | Madalyn Kelly Yowell | Technician | 7809 Southeast Southgate Street, Milwaukee, OR 97222 | 2019-10-16 |
| 1336617448 | Nadia Yang | Social Worker | 2115 Se Adams St, Milwaukie, OR 97222 | 2018-11-06 |
| 1851892368 | Arrow Dental LLC | Dentist | 10505 Se 17th Avenue, Milwaukie, OR 97222 | 2018-02-21 |
| 1851814016 | Cathy Maria Andrew | Acupuncturist | 11022 Se Stanley Ave, Milwaukie, OR 97222 | 2017-07-19 |
| 1972025369 | Sarah Elizabeth Giles | Peer Specialist | 11097 Se 21st Ave., Milwaukie, OR 97222 | 2017-07-07 |
| 1366976292 | Brittany Reubendale | Physical Therapist | 12705 See River Rd, Portland, OR 97222 | 2017-04-18 |
| 1669916383 | Margie Hertz | Registered Nurse | 6406 Se Cedarcrest Drive, Milwaukie, OR 97222 | 2016-12-14 |
| 1952858094 | Alexis Escobar | Speech-Language Pathologist | 4560 Se International Way, Ste 100, Milwaukie, OR 97222 | 2016-09-07 |
| 1205295466 | Beth Ann Mills | Acupuncturist | 2025 Se Jefferson St Ste 106, Milwaukie, OR 97222 | 2016-02-16 |
| 1558744086 | Kyle Eugene Coan | Specialist | 3306 Se Wister St, Milwaukie, OR 97222 | 2015-07-01 |
| Find all providers in zip 97222 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982175378 | Tye Dewald | Peer Specialist | 11073 Se Main St, Milwaukie, OR 97222-7645 | 2018-12-10 |
| 1972025369 | Sarah Elizabeth Giles | Peer Specialist | 11097 Se 21st Ave., Milwaukie, OR 97222 | 2017-07-07 |
| 1891246872 | Margaret Barnett | Peer Specialist | 4550 Se King Rd, Milwaukie, OR 97222-5233 | 2016-10-14 |
| 1902411481 | Jesus Jassed Nunez-pineda | Peer Specialist | 11073 Se Main St, Milwaukie, OR 97222-7645 | 2020-09-11 |
| 1477170892 | Jasper Adams | Peer Specialist | 11073 Se Main St, Milwaukie, OR 97222-7645 | 2020-07-01 |
| 1508483223 | Nikobi Petronelli | Peer Specialist | 11073 Se Main St, Milwaukie, OR 97222-7645 | 2020-06-29 |
| 1407358799 | Solmaira Trujillo | Peer Specialist | 11097 Se 21st Ave, Milwaukie, OR 97222-7640 | 2018-03-02 |
| 1578065868 | Darrin Hernandez | Peer Specialist | 11097 Se 21st Ave, Milwaukie, OR 97222-7640 | 2018-03-02 |
| 1629584529 | Mark Rioux | Peer Specialist | 2808 Se Balfour St, Milwaukie, OR 97222-6426 | 2017-12-14 |
| 1366963860 | Lauren Conn | Peer Specialist | 11097 Se 21st Ave, Milwaukie, OR 97222-7640 | 2017-07-05 |
| Find all providers in MILWAUKIE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.