MEDICARE: ELLIE DELONEY

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		ID

General Provider Information

NPI Number	:	1871460808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIE DELONEY

Provider Business Mailing Address
First Line	:	600 W ANDERSON ST APT 3102
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-2069
Country	:	US
Telephone Number	:	608-354-3713
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 E 17TH ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6469
Country	:	US
Telephone Number	:	208-497-0085
Fax Number	:

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

Provider Enumeration Date	:	10/23/2025
Last Update Date	:	10/23/2025

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Directions to “ ELLIE DELONEY ” Practice Location

Language	Start Address	Practice Location

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