Provider Demographics
NPI:1407664527
Name:ELLRICH, SCOTT W
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:ELLRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10077 SUNDOWN LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9856
Mailing Address - Country:US
Mailing Address - Phone:317-432-6014
Mailing Address - Fax:
Practice Address - Street 1:10077 SUNDOWN LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9856
Practice Address - Country:US
Practice Address - Phone:317-432-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251S00000XAgenciesCommunity/Behavioral Health