Provider Demographics
NPI:1780552018
Name:MOORE, ELLA ANN
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W 1ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1782
Mailing Address - Country:US
Mailing Address - Phone:515-261-2402
Mailing Address - Fax:515-414-7642
Practice Address - Street 1:220 W 1ST ST STE 100
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1782
Practice Address - Country:US
Practice Address - Phone:515-261-2402
Practice Address - Fax:515-414-7642
Is Sole Proprietor?:No
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician