Individual
MS. BREANNA JANE MINOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
901 CALEDONIA ST, LA CROSSE, WI 54603-2616
(608) 785-4100
Mailing address
901 CALEDONIA ST, LA CROSSE, WI 54603-2616
(608) 785-4100
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4117-154
WI
235Z00000X
Speech-Language Pathologist
9463
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4117-154
WISCONSIN DSPS
WI
01
—
9463
MDH
MN
Enumeration date
05/29/2015
Last updated
01/23/2017
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