Individual
MISS ELLEN ALEXANDRA THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PC-IT
Contact information
Practice address
16275 W WISCONSIN AVE, APT 312, BROOKFIELD, WI 53005
(901) 644-3910
Mailing address
16275 W WISCONSIN AVE, APT 312, BROOKFIELD, WI 53005
(901) 644-3910
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2311-226
WI
101Y00000X
Counselor
—
—
Other
Enumeration date
11/12/2014
Last updated
11/12/2014
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