Individual
BREANNA NICOLE HICKENBOTTOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20601 N 19TH AVE STE 100, PHOENIX, AZ 85027-2666
(888) 754-0398
Mailing address
110 W BELL RD APT 230, PHOENIX, AZ 85023-7493
(331) 229-6068
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
AZ
Other
Enumeration date
06/03/2026
Last updated
06/03/2026
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