Individual
DR. CORNELIA ELLIS GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
419 PLEASANT ST, SUITE 313, BELOIT, WI 53511-6249
(608) 365-7078
(608) 365-7464
Mailing address
419 PLEASANT ST, SUITE 313, BELOIT, WI 53511-6249
(608) 365-7078
(608) 365-7464
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
951-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39027300
—
WI
Enumeration date
01/23/2007
Last updated
07/08/2007
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