Individual
EMILY ANNE ELLENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LLP
Contact information
Practice address
300 S STATE ST STE 13, ZEELAND, MI 49464-1678
(616) 772-1733
Mailing address
6328 VILLAGE LN, ZEELAND, MI 49464-8250
(616) 990-3402
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301012310
MI
103T00000X
Psychologist
Primary
6361000735
MI
Other
Enumeration date
06/11/2006
Last updated
12/28/2022
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