Individual
TAYLOR ELLENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
850 SW 4TH ST, MADRAS, OR 97741-9628
(541) 475-6575
Mailing address
PO BOX 1710, REDMOND, OR 97756-0516
(541) 516-4097
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000106409
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
THW000106409
PEER SUPPORT
OR
Enumeration date
04/25/2022
Last updated
04/25/2022
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