Individual
BRODERICK AUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1201 W BROADWAY AVE, MINNEAPOLIS, MN 55411-2532
(612) 616-2974
Mailing address
1201 W BROADWAY AVE, MINNEAPOLIS, MN 55411-2532
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/23/2024
Last updated
01/23/2024
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