Provider Demographics
NPI:1194938548
Name:ELLENBURG, ROSEMARY (MSW)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:ELLENBURG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 GARLOCK LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3118
Mailing Address - Country:US
Mailing Address - Phone:719-457-0660
Mailing Address - Fax:719-457-0766
Practice Address - Street 1:2812 E BIJOU ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6371
Practice Address - Country:US
Practice Address - Phone:719-457-0660
Practice Address - Fax:719-457-0766
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COUNLICENSED104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker