Individual
BRIANNA FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2537 EISENHOWER RD, OTTAWA, KS 66067-9482
(785) 242-3780
(785) 242-6397
Mailing address
PO BOX 677, OTTAWA, KS 66067-0677
(785) 242-3780
(785) 242-6397
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
KIPBS - 99-07
KS
Other
Enumeration date
04/03/2014
Last updated
04/11/2014
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