Provider Demographics
NPI:1184011025
Name:NITCHALS-KELLNER, ELLYN
Entity Type:Individual
Prefix:
First Name:ELLYN
Middle Name:
Last Name:NITCHALS-KELLNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 DUFF AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6391
Mailing Address - Country:US
Mailing Address - Phone:515-815-6466
Mailing Address - Fax:515-619-6207
Practice Address - Street 1:511 DUFF AVE STE 301
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6391
Practice Address - Country:US
Practice Address - Phone:515-815-6466
Practice Address - Fax:515-619-6207
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health