Individual
BREANNA INGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4108 FIELDSTONE RD STE A, CHAMPAIGN, IL 61822-8808
(630) 945-4964
Mailing address
4108 FIELDSTONE RD STE A, CHAMPAIGN, IL 61822-8808
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-209026
IL
Other
Enumeration date
03/06/2019
Last updated
03/18/2025
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