Individual
BREANNA GIPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14045 KILPATRICK AVE, CRESTWOOD, IL 60418-2298
(312) 257-8544
Mailing address
14045 KILPATRICK AVE, CRESTWOOD, IL 60418-2298
(312) 257-8544
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
IL
Other
Enumeration date
03/29/2019
Last updated
03/29/2019
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