Marilyn Elizabeth Ellis

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

14387 Edgewood Dr
Baxter, MN 56425-8460

Phone

(218) 454-5181

NPI assigned

Dec 14, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mari Beth Ellis Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1902565161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14387 EDGEWOOD DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258460",
            "telephone_number": "218-454-5181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14387 EDGEWOOD DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258460",
            "telephone_number": "218-454-5181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARILYN",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-14",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARI BETH",
            "last_name": "ELLIS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jessica Ann Eastman, CNP
• Dawn Marie Eckstrom
• Edgewood Baxter LLC
• Kevin James Edwards, PH.D.
• Elite Sleep Solutions, LLC
• Amber Endres, LGSW
• McKenzie Lou Engebretson
• Amy Elise Engen
• Deborah Anna Erickson, MA MFT
• Wayne C Erickson, PT

• Behavior Analyst in Baxter, MN
• Providers in Baxter, MN by specialty
• Behavior Analyst in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.