| NPI | 1023247897 |
|---|---|
| Former Name | BETHANY J ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2024041712) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2024-12-18 |