Individual
SHELBY LYN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1975 BELMONT AVE, IDAHO FALLS, ID 83404-6409
(208) 716-1027
Mailing address
1975 BELMONT AVE, IDAHO FALLS, ID 83404-6409
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RK209943K
DRIVERS LICENCE
ID
Enumeration date
07/08/2020
Last updated
07/08/2020
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