Individual
DR. AUDREY ERLENE ELLENWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
6400 MONROE ST, SUITE E, SYLVANIA, OH 43560-1453
(419) 885-4121
Mailing address
5303 SPRING CREEK LN, SYLVANIA, OH 43560-1317
(419) 885-4121
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3998
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023158
—
OH
Enumeration date
08/19/2006
Last updated
07/08/2007
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