Individual
JEANNIE ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
445 W MICHIGAN AVE, KALAMAZOO, MI 49007-3750
(269) 488-3957
Mailing address
445 W MICHIGAN AVE, KALAMAZOO, MI 49007-3750
(269) 488-5460
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
5303020611
MI
Other
Enumeration date
06/16/2021
Last updated
06/16/2021
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