Individual
JENNIFER ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
PSS
Contact information
Practice address
761 CHEMAWA RD N, KEIZER, OR 97303-5714
(971) 398-7744
Mailing address
761 CHEMAWA RD N, KEIZER, OR 97303-5714
(971) 398-7744
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
112617
OR
Other
Enumeration date
11/16/2024
Last updated
11/16/2024
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