Individual
MARY C ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11080 ROARING FORK ST, CALDWELL, ID 83605-2078
(949) 306-7962
Mailing address
11080 ROARING FORK ST, CALDWELL, ID 83605-2078
(949) 306-7962
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
ID
Other
Enumeration date
11/18/2020
Last updated
06/05/2025
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