Healthcare Provider Details

I. General information

NPI: 1710820287
Provider Name (Legal Business Name): ELLE MARSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SOUTHGATE STE 10
PENDLETON OR
97801-3973
US

IV. Provider business mailing address

3729 KLINDT DR
THE DALLES OR
97058-3566
US

V. Phone/Fax

Practice location:
  • Phone: 541-298-2101
  • Fax: 541-298-7996
Mailing address:
  • Phone: 541-298-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: