Individual
BRAKEAL EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
308 W 100 N, JEROME, ID 83338-5260
(208) 420-3109
Mailing address
308 W 100 N, JEROME, ID 83338-5260
(208) 420-3109
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
11/11/2024
Last updated
11/11/2024
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