Provider Demographics
NPI:1912236159
Name:ELLIS, WENDY LEIGH (ND)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:LEIGH
Last Name:ELLIS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2611 NE 125TH STREET - SUITE 228
Mailing Address - Street 2:SUITE 228
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125
Mailing Address - Country:US
Mailing Address - Phone:206-402-4215
Mailing Address - Fax:206-257-4468
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:SUITE 228
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-402-4215
Practice Address - Fax:206-257-4468
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WANT 00001394175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath