Individual provider · Type 1 NPI

Ellie A. Blackburn

Clinical Social Worker · Grand Rapids, MI

NPI number 1861254518 Active

Practice location

678 Front Ave NW
Grand Rapids, MI 49504-5325

Call (616) 916-3711 Map

Mailing address

130 Brookmeadow North Ct SW Apt 8
Grandville, MI 49418-3247

Specialties and licenses

TaxonomyCodeLicense
Clinical Social Worker Primary 1041C0700X6851121335 (MI)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1861254518

Ellie A. Blackburn's National Provider Identifier is 1861254518, issued on Jan 29, 2024. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Grand Rapids, MI. The record was last updated on Feb 3, 2026.