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NPI Code Detail

MEDICARE: JA'LYN ELLISON

MEDICARE: JA'LYN ELLISON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1720763642
Entity Type Code : Individual
Provider Name (Legal Business Name) : JA'LYN ELLISON
Provider Business Mailing Address
First Line : 4700 IRVING BLVD NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87114-4283
Country : US
Telephone Number : 866-727-8274
Fax Number :
Provider Business Practice Location Address
First Line : 4700 IRVING BLVD NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87114-4283
Country : US
Telephone Number : 866-727-8274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2023
Last Update Date : 06/19/2023

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Directions to “ JA'LYN ELLISON ” Practice Location

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