Individual
ELLESE SHARP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
840 E PLUM ST, MOSES LAKE, WA 98837-1874
(509) 765-9239
Mailing address
840 E PLUM ST, MOSES LAKE, WA 98837-1874
(509) 765-9239
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CG61017459
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG61017459
AGENCY AFFILIATED
WA
Enumeration date
08/28/2020
Last updated
08/28/2020
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