Provider Demographics
NPI:1962747923
Name:CLEARY-PENNINGER, ELLEN ANN (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:ANN
Last Name:CLEARY-PENNINGER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:ANN
Other - Last Name:PENNINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSWAIC
Mailing Address - Street 1:3208 50TH STREET CT STE 205A
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8486
Mailing Address - Country:US
Mailing Address - Phone:425-650-0101
Mailing Address - Fax:425-650-0102
Practice Address - Street 1:3208 50TH STREET CT STE 205A
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8486
Practice Address - Country:US
Practice Address - Phone:425-650-0101
Practice Address - Fax:425-650-0102
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW605158951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical