Provider Demographics
NPI:1790530269
Name:ELLIS, ALEAH BETH
Entity Type:Individual
Prefix:
First Name:ALEAH
Middle Name:BETH
Last Name:ELLIS
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 1:5585 ROSEBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-5777
Mailing Address - Country:US
Mailing Address - Phone:513-388-1028
Mailing Address - Fax:
Practice Address - Street 1:5585 ROSEBROOK WAY
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-5777
Practice Address - Country:US
Practice Address - Phone:513-388-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program