Provider Demographics
NPI:1750784724
Name:HEPHZIBAH, ELLA
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:HEPHZIBAH
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 1:1905 4TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-4039
Mailing Address - Country:US
Mailing Address - Phone:517-513-3657
Mailing Address - Fax:517-513-3693
Practice Address - Street 1:1190 N WEST AVE STE 812
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2047
Practice Address - Country:US
Practice Address - Phone:517-513-3657
Practice Address - Fax:517-513-3693
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management