Individual
DR. KENNETH J ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1106 COLUMBIA AVE, SUITE 100, MARYSVILLE, WA 98270-4335
(360) 653-0374
(360) 658-0219
Mailing address
1106 COLUMBIA AVE, SUITE 100, MARYSVILLE, WA 98270-4335
(360) 653-0374
(360) 658-0219
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY00003392
WA
Other
Enumeration date
07/15/2006
Last updated
02/12/2016
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