Individual
JORDYN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
210 WISCONSIN AMERICAN DR, FOND DU LAC, WI 54937-2999
(920) 410-4119
Mailing address
210 WISCONSIN AMERICAN DR, FOND DU LAC, WI 54937-2999
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100287332
—
WI
Enumeration date
08/19/2024
Last updated
10/18/2024
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