Individual
AMANDA ELLISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDN, CLC
Contact information
Practice address
12 GLENN DR, WILBRAHAM, MA 01095-1404
(413) 695-2884
Mailing address
12 GLENN DR, WILBRAHAM, MA 01095-1404
(413) 695-2884
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
3157
MA
174N00000X
Lactation Consultant (Non-RN)
20983
MA
Other
Enumeration date
10/21/2022
Last updated
02/03/2026
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