Individual
BREANNA KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
451 S PARK RIDGE RD STE 102, BLOOMINGTON, IN 47401-8589
(317) 334-7331
(317) 334-7336
Mailing address
3106 N CANTERBURY CT, BLOOMINGTON, IN 47404-1500
(317) 334-7331
(317) 334-7336
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB558539
IN
Other
Enumeration date
08/19/2021
Last updated
04/14/2025
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