Individual
ELLIE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
415 MEDICAL DR STE A100, BOUNTIFUL, UT 84010-4995
(801) 683-1062
Mailing address
415 MEDICAL DR STE A100, BOUNTIFUL, UT 84010-4995
(801) 683-1062
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055266
MEDICARE PIN
UT
01
—
260022408
RAILROAD MEDICARE
UT
05
—
8760003008007
—
UT
Enumeration date
11/22/2022
Last updated
10/24/2025
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