Provider Demographics
NPI:1467023291
Name:ELLIS, ZAYDIA (BS)
Entity type:Individual
Prefix:
First Name:ZAYDIA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2369 W ORTON CIR STE 20
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-7603
Mailing Address - Country:US
Mailing Address - Phone:385-715-1511
Mailing Address - Fax:
Practice Address - Street 1:2369 W ORTON CIR STE 20
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-7603
Practice Address - Country:US
Practice Address - Phone:385-715-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician