Provider Demographics
NPI:1659985166
Name:WETEKAMP, ELLEN MARIE (BS)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:WETEKAMP
Suffix:
Gender:
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 N GARFIELD AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-7502
Mailing Address - Country:US
Mailing Address - Phone:626-387-6996
Mailing Address - Fax:626-898-9298
Practice Address - Street 1:41 N GARFIELD AVE STE 207
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-387-6996
Practice Address - Fax:626-898-9298
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-20-112570106S00000X
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician