Individual
MRS. ELIZABETH KENETTE ELLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NBC-HIS
Contact information
Practice address
720 N MERIDIAN, BLACKFOOT, ID 83221
(208) 785-5551
(208) 782-9580
Mailing address
4155 YELLOWSTONE AVE, POCATELLO, ID 83202-2345
(208) 238-0020
(208) 238-0021
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
HA-182
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00441300
—
ID
05
—
4414100
—
ID
Enumeration date
11/16/2006
Last updated
06/03/2021
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