Healthcare Provider Details

I. General information

NPI: 1043128051
Provider Name (Legal Business Name): ELLIE BRENNAN NUTRITION COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4379 BROOKSIDE LN UNIT B
BOZEMAN MT
59718-6377
US

IV. Provider business mailing address

4379 BROOKSIDE LN UNIT B
BOZEMAN MT
59718-6377
US

V. Phone/Fax

Practice location:
  • Phone: 406-564-7088
  • Fax:
Mailing address:
  • Phone: 406-564-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ELLIE ANNE BRENNAN
Title or Position: REGISTERED DIETITIAN
Credential: MS, RDN, LD
Phone: 406-564-7088