Individual
BREANNE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1606 HUNT DR, NORMAL, IL 61761-2192
(309) 451-8888
(309) 451-8989
Mailing address
1606 HUNT DR, NORMAL, IL 61761-2192
(309) 451-8888
(309) 451-8989
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-35887
IL
106S00000X
Behavior Technician
16-22497
IL
Other
Enumeration date
05/17/2019
Last updated
07/29/2020
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