Individual
JENNIFER CONSTANCE BRAENDEHOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 E PRATT ST, BALTIMORE, MD 21202-3116
(855) 832-6727
Mailing address
400 E PRATT ST, BALTIMORE, MD 21202-3116
(855) 832-6727
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LBA739
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700024296
TRI CARE HUMANA
MD
05
—
1700024296
—
MD
Enumeration date
01/15/2020
Last updated
01/15/2020
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