Individual
JAMIE KATHRYN BRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3761 JOHNSON HALL DR, MASONIC HOME, KY 40041-9998
(502) 293-1695
Mailing address
1312 OAK RIDGE CT, SIMPSONVILLE, KY 40067-6668
(502) 321-7590
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
B20-378-64C
KY
Other
Enumeration date
11/08/2024
Last updated
11/08/2024
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