Individual
MONIQUE BRISSETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 373-3202
(260) 373-4548
Mailing address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 373-3202
(260) 373-4548
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
46003495A
IN
Other
Enumeration date
04/10/2019
Last updated
04/10/2019
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