Individual
ELLEN JOYCE ELLINGSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, CD
Contact information
Practice address
707 S UNIVERSITY AVE, BEAVER DAM, WI 53916-3027
(920) 887-5922
Mailing address
707 S UNIVERSITY AVE, BEAVER DAM, WI 53916-3027
(920) 887-5922
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86051524
WI
Other
Enumeration date
10/31/2017
Last updated
10/31/2017
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