Individual
STACY LYNN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2621 NE 134TH ST STE 340, VANCOUVER, WA 98686-3036
(360) 450-0140
Mailing address
2204 SE 12TH AVE APT C, PORTLAND, OR 97214-5338
(310) 991-5923
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY60509345
WA
Other
Enumeration date
07/10/2011
Last updated
08/17/2015
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