Individual
BRANDE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
306 N 2ND ST, PIEDMONT, MO 63957-1301
(573) 223-4169
Mailing address
925 HIGHWAY VV, KENNETT, MO 63857
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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