Individual
JAZIMINE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2222 S 114TH ST, WEST ALLIS, WI 53227-1031
(414) 449-4444
Mailing address
2222 S 114TH ST, WEST ALLIS, WI 53227-1031
(414) 449-4444
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
11/21/2014
Last updated
11/21/2014
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