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Individual

NICOLE ELLISH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
BCBA

Contact information

Practice address
10450 72ND AVE, PLEASANT PRAIRIE, WI 53158-2911
(262) 657-6453
Mailing address
PO BOX 51322, BOWLING GREEN, KY 42102-5622
(270) 777-9283
(270) 777-9283

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
11725028
IL
103K00000X
Behavior Analyst
176-140
WI

Other

Enumeration date
04/05/2017
Last updated
10/03/2020
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