Individual
BRANDI ELIZABETH BURQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
3915 ROCKDALE DR, CHAMPAIGN, IL 61822-2051
(954) 802-7419
Mailing address
3915 ROCKDALE DR, CHAMPAIGN, IL 61822-2051
(954) 802-7419
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1614
AL
Other
Enumeration date
08/24/2009
Last updated
04/05/2013
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