Provider Demographics
NPI:1255002119
Name:LUDWIG, ELLEN (MS LAC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6747 E PRESIDIO RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3935
Mailing Address - Country:US
Mailing Address - Phone:310-936-9160
Mailing Address - Fax:
Practice Address - Street 1:4545 N 36TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3473
Practice Address - Country:US
Practice Address - Phone:480-525-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-010725171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist