Individual
BREANNA CORDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6300 W OLD SHAKOPEE RD STE 102, BLOOMINGTON, MN 55438-2684
(612) 509-6671
Mailing address
3813 BAILLIF PL, BLOOMINGTON, MN 55431-3520
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X234-247-257-109
DRIVERS LICENSE NUMBER
MN
Enumeration date
01/04/2021
Last updated
01/04/2021
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