Individual
BRIANNA VANSICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2003 NORTHMOOR TER, PUEBLO, CO 81008-1505
(719) 542-6701
Mailing address
115 W 2ND ST, PUEBLO, CO 81003-3223
(719) 546-0572
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0001831
CO
Other
Enumeration date
08/12/2014
Last updated
08/12/2014
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