Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1225226442 |
---|---|
Provider Name | Ashlea Lynn Brandenburg |
First Address | Champaign, IL 61820-2623 |
Second Address | Champaign, IL 61820-2623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2007 |
Last Update Date | 12/10/2007 |