Individual
MRS. JVONNE L ELLINGSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCDCT
Contact information
Practice address
123 19TH STREET NE, WATERTOWN, SD 57201
(605) 886-0123
(605) 886-5447
Mailing address
PO BOX 1030, WATERTOWN, SD 57201
(605) 886-0123
(605) 886-5447
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4293
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5001040
—
SD
Enumeration date
09/14/2006
Last updated
07/08/2007
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