Individual
BREANNA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2504 WATERBRIDGE WAY, EVANSVILLE, IN 47710-3200
(812) 646-2604
Mailing address
11807 ALLISONVILLE RD # 522, FISHERS, IN 46038-2313
(317) 572-5315
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-23-254015
IN
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/13/2025
Last updated
06/18/2025
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