Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | AZ |
NPI | 1114103272 |
---|---|
Provider Name | Ms. Chantel Lanae Ellsworth |
First Address | Gilbert, AZ 85295-7846 |
Second Address | Gilbert, AZ 85295-7846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2008 |
Last Update Date | 11/02/2008 |