Individual
BRENDA BOLLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1055 BAY BREEZE DR, SUFFOLK, VA 23435-3274
(757) 375-6403
Mailing address
1055 BAY BREEZE DR, SUFFOLK, VA 23435-3274
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133000793
VA
Other
Enumeration date
07/19/2016
Last updated
07/19/2016
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