Individual
MRS. JESSICA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2132 S 12TH ST STE 103, ALLENTOWN, PA 18103-4814
(484) 359-3447
Mailing address
3664 VISTA DR, MACUNGIE, PA 18062-2139
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
PC009799
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851775704
—
PA
Enumeration date
07/09/2015
Last updated
09/25/2020
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