Most Relevant Information
Provider Data
| NPI Number: | 1003323544 |
| Provider Name: | BREANNE CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | 16-24244 |
Most Important Dates
| Enumeration Date: | 01/05/2018 |
| Last Updated: | 01/05/2018 |
Provider Practice Location
7552 NAVARRE PKWY UNIT 36
NAVARRE
FL
325667309
Practice Location Phone/Fax
| Phone: | 8509394190 |
| Fax: |
Provider Mailing Location
3771 STEFANI RD
CANTONMENT
FL
325337795
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |