Individual
STEPHANIE CLARK ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
110 CREEK LOCKS RD, ROSENDALE, NY 12472-9678
(845) 546-5358
Mailing address
7 KELLARS LN, TILLSON, NY 12486-1224
(845) 546-5358
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
001927
NY
Other
Enumeration date
02/03/2007
Last updated
07/08/2007
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