Samantha Jo Ellis

NPI #1841959533 in Wake Forest, North Carolina

Provider Information

NPI Number: 1841959533
Entity Type: Individual
Name: Samantha Jo Ellis
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Dec 10, 2021
Last Updated: Dec 10, 2021

Practice Location

Address: 1530 WOODFIELD CREEK DR APT 205
City: Wake Forest
State: North Carolina
ZIP Code: 27587-4758
Phone: (919) 889-4990

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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