Shannon Ellis

Clinical Social Worker · Columbus, MS

Individual Active NPI

NPI number 1417604331

Practice location

75 Wood Glen Ln
Columbus, MS 39705-3273
Phone
(662) 574-2150

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NPI record

NPI
1417604331
Entity type
Individual (Type 1)
Enumeration date
March 10, 2022
Last updated
October 16, 2025
Certified
October 16, 2025
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Clinical Social Worker Primary 1041C0700X C11725 MS
Clinical Social Worker 1041C0700X 6518C AL

About Shannon Ellis

Shannon Ellis is a healthcare provider registered in the NPI registry with the primary taxonomy Clinical Social Worker (code 1041C0700X). The practice location is 75 Wood Glen Ln, Columbus, MS 39705-3273. The NPI number 1417604331 was assigned on March 10, 2022 and the record was last updated on October 16, 2025.

Shannon Ellis lists 2 licenses in the registry: #C11725 (MS) for Clinical Social Worker; #6518C (AL) for Clinical Social Worker. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Shannon Ellis?

The NPI number is 1417604331.

What is the phone number of Shannon Ellis?

The phone number listed for the practice location is (662) 574-2150.

Where is Shannon Ellis located?

75 Wood Glen Ln, Columbus, MS 39705-3273.

What is the taxonomy code for Shannon Ellis?

The primary taxonomy code is 1041C0700X – Clinical Social Worker; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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