Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist | ||
N | 106S00000X | Behavior Technician |
NPI | 1134780398 |
---|---|
Provider Name | Breanne Pearson |
First Address | Wrangell, AK 99929-1231 |
Second Address | Wrangell, AK 99929-9992 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2019 |
Last Update Date | 27/06/2019 |