DR. AUDREY ERLENE ELLENWOOD (PH.D.) – Psychologist, NPI 1265547681

DR. AUDREY ERLENE ELLENWOOD (PH.D.) is a healthcare provider. based in Sylvania, Ohio. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PH.D.. They hold a License No. 3998 (OH). The NPI Number for DR. AUDREY ERLENE ELLENWOOD (PH.D.) is 1265547681

Main info

Female
Sole Proprietor
39 Years Of Experience
Accepts Medicare Assignment
Name
DR. AUDREY ERLENE ELLENWOOD (PH.D.)
NPI
1265547681
Phone
(419) 885-4121
Address
6400 MONROE ST
Enumeration Date
19 August 2006
Last Update Date
8 July 2007

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1987 (39 years ago)
PAC ID
2668655622
Professional Enrollment ID
I20110329000323
Address ID
OH435601400SY6400XEXXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

1,139 CLINICAL PSYCHOLOGIST in OH

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Provider Addresses for DR. AUDREY ERLENE ELLENWOOD (PH.D.)

  • 6400, Monroe Street, Sylvania, Lucas County, Ohio, 43560, United States

    SUITE E

    SYLVANIA, OH 435601453

    Phone: (419) 885-4121

    Type: Location

  • 5303, Spring Creek Lane, The Meadows, Sylvania, Lucas County, Ohio, 43560, United States

    SYLVANIA, OH 435601317

    Phone: (419) 885-4121

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2011-03-29

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20110329000323IClinical PsychologistOHTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 43560)

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Reviews

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Frequently asked questions

Is there an official ID for DR. AUDREY ERLENE ELLENWOOD (PH.D.) in U.S. healthcare records?
The official identifier for DR. AUDREY ERLENE ELLENWOOD (PH.D.) is NPI 1265547681.
Is there an active status for DR. AUDREY ERLENE ELLENWOOD (PH.D.)?
For scheduling context, DR. AUDREY ERLENE ELLENWOOD (PH.D.) is shown as active in the registry.
What area of care is associated with DR. AUDREY ERLENE ELLENWOOD (PH.D.)?
DR. AUDREY ERLENE ELLENWOOD (PH.D.)'s record emphasizes Psychologist. Clinical services aligned with this taxonomy classification.
Where in Ohio is DR. AUDREY ERLENE ELLENWOOD (PH.D.) registered?
Use Sylvania, Ohio as the headline location for DR. AUDREY ERLENE ELLENWOOD (PH.D.) here.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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