| Doctor Name: | TRACI ELLERSHAW |
| NPI Number: | 1538310180 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 1964-123 |
| Business Practice Address: | 15285 Watertown Plank Rd Elm Grove, WI - 531222339 |
| Business Phone Number: | 2627972818 |
| Business Fax Number: | 2627972814 |
| Mailing Address: | 7330 W Layton Ave, MILWAUKEE |
| State: | WI |
| Postal Code: | 532203849 |
| Phone Number: | 4148178896 |
| Fax Number: | 4148178940 |
| NPI Enumeration Date: | 10/01/2008 |
| NPI Last Update Date: | 10/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 1964-123 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |