MEDICARE: ELISE ADELAINE WELLS

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	106S00000X	Behavior Technician	CBT.CB.70077427	WA

General Provider Information

NPI Number	:	1235088055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE ADELAINE WELLS

Provider Business Mailing Address
First Line	:	1605 WOODRIDGE DR SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3818
Country	:	US
Telephone Number	:	360-443-2399
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 WOODRIDGE DR SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3818
Country	:	US
Telephone Number	:	360-443-2399
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ ELISE ADELAINE WELLS ” Practice Location

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