Provider Demographics
NPI:1265837322
Name:ELLS, LINDA
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:ELLS
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 1:1221 GEAR AVENUE
Mailing Address - Street 2:MERCY PLAZA SUITE 251
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655
Mailing Address - Country:US
Mailing Address - Phone:319-768-3731
Mailing Address - Fax:319-768-3712
Practice Address - Street 1:1221 S GEAR AVE
Practice Address - Street 2:MERCY PLAZA SUITE 251
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1679
Practice Address - Country:US
Practice Address - Phone:319-768-3731
Practice Address - Fax:319-768-3712
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0763101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)