Individual
BROOKLYN SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1302 FRANKLIN AVE STE L500, NORMAL, IL 61761-3551
(309) 834-0080
Mailing address
2000 JACOBSSEN DR, NORMAL, IL 61761-6277
(309) 451-8888
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/11/2023
Last updated
05/11/2023
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