Individual
MS. LISA A ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
309 S FAIR ST, CHAMPAIGN, IL 61821-3122
(217) 377-9348
Mailing address
309 S FAIR ST, CHAMPAIGN, IL 61821-3122
(217) 377-9348
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
01/28/2009
Last updated
04/24/2014
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