Individual
ELLIS PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1613 PROSPECT PKWY, SUITE 110, FORT COLLINS, CO 80525-9707
(303) 989-8169
Mailing address
1613 PROSPECT PKWY, SUITE 110, FORT COLLINS, CO 80525-9707
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/06/2021
Last updated
10/06/2021
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