MEDICARE: ELLIE MORRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	M620213085605	MI

General Provider Information

NPI Number	:	1447551395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIE MORRIS

Provider Business Mailing Address
First Line	:	848 W WAVELAND AVE
Second Line	:	1
City	:	CHICAGO
State	:	IL
Zip	:	60613-4334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	848 W WAVELAND AVE
Second Line	:	1
City	:	CHICAGO
State	:	IL
Zip	:	60613-4334
Country	:	US
Telephone Number	:	586-484-2851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	12/14/2010

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