Individual provider · Type 1 NPI

Anne Ellingson, PROVISIONAL

Addiction (Substance Use Disorder) Counselor · Jackson, WY

NPI number 1841665668 Active

Practice location

610 W Broadway Ave, Suite L1
Jackson, WY 83001-8213

Call (307) 733-3908 Map

Fax (307) 734-0017

Mailing address

PO Box 11390
Jackson, WY 83002-1390

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XPAT-073 (WY)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1841665668

Anne Ellingson, PROVISIONAL's National Provider Identifier is 1841665668, issued on Dec 4, 2015. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Jackson, WY. The record was last updated on Dec 4, 2015.