Individual
AMANDA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 SAINT ANDREWS RD STE 408, SAGINAW, MI 48638
(989) 401-9020
Mailing address
PO BOX 663, LAKELAND, MI 48143-0663
(810) 559-2129
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/25/2019
Last updated
09/26/2019
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