Individual
BREANNA BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3319 N ELSTON AVE, CHICAGO, IL 60618-5811
(312) 733-0833
Mailing address
16643 WEDGEWOOD AVE, MARKHAM, IL 60428-5347
(708) 541-9929
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/28/2024
Last updated
10/28/2024
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