Charles Ellison

NPI #1225419682 in Provo, Utah

Provider Information

NPI Number: 1225419682
Entity Type: Individual
Name: Charles Ellison
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Case Manager/Care Coordinator
Enumeration Date: Jun 11, 2015
Last Updated: Jun 11, 2015

Practice Location

Address: 750 N FREEDOM BLVD
City: Provo
State: Utah
ZIP Code: 84601-1677
Phone: (801) 373-4760

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Manager/Care Coordinator	171M00000X	Primary

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