Individual
BRYNNE WICKLUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
545 LAUREL ST, SAN DIEGO, CA 92101-1634
(619) 233-4399
Mailing address
545 LAUREL ST, SAN DIEGO, CA 92101-1634
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-21-181872
CO
225400000X
Rehabilitation Practitioner
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/23/2021
Last updated
05/14/2026
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