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Individual

LAUREN ELIZABETH ELLSWORTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
444 HOSPITAL WAY STE 477, POCATELLO, ID 83201-2744
(208) 233-7832
Mailing address
444 HOSPITAL WAY STE 477, POCATELLO, ID 83201-2744
(208) 233-7832

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CPSS415
ID

Other

Enumeration date
06/26/2017
Last updated
07/21/2022
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