Provider Demographics
NPI:1386620375
Name:DUNCAN, ELLA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELLA
Middle Name:M
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EAGLE CTR STE B-1
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1946
Mailing Address - Country:US
Mailing Address - Phone:618-581-2984
Mailing Address - Fax:618-256-7246
Practice Address - Street 1:7 EAGLE CTR STE B-1
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1946
Practice Address - Country:US
Practice Address - Phone:618-726-2041
Practice Address - Fax:618-726-2043
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0115081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical