Individual
BRANDI F BLANKENBECKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 GROWTH PKWY STE F-G, ANGOLA, IN 46703-9343
(260) 459-6040
Mailing address
10820 COLDWATER RD, FORT WAYNE, IN 46845-1241
(260) 459-6040
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
18-65640
IN
Other
Enumeration date
01/02/2019
Last updated
01/02/2019
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