Individual
SHANNON BRECKENRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1800 TULLY RD # STUA-2, MODESTO, CA 95350-2946
(209) 622-1420
Mailing address
972 OAK GROVE RD, MODESTO, CA 95351
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
68828
CA
Other
Enumeration date
08/15/2014
Last updated
08/15/2014
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