Individual
BROOKE MARIE EDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4140 RICHARD AVE STE 200, HERMANTOWN, MN 55811-3309
(218) 520-3411
Mailing address
4140 RICHARD AVE, HERMANTOWN, MN 55811-2869
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588993091
—
MN
Enumeration date
01/03/2023
Last updated
01/03/2023
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