Individual
BROOK WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1319 N GALENA AVE, DIXON, IL 61021-1009
(815) 627-0868
Mailing address
1319 N GALENA AVE, DIXON, IL 61021-1009
(815) 627-0868
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-312267
IL
Other
Enumeration date
11/21/2023
Last updated
11/21/2023
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