Individual
JAMES BRAYTON ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
775 E ELIZA ST, KENTON, OH 43326-1486
(419) 675-2243
Mailing address
775 E ELIZA ST, KENTON, OH 43326-1486
(419) 675-2243
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S1701216
OH
Other
Enumeration date
05/14/2018
Last updated
05/14/2018
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