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1104547702
BREANNA LOGAN CLUBB
MASCOUTAH, IL
NPI
1104547702
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2022-09-12
Last Update Date
2022-09-12
Business Address
BREANNA LOGAN CLUBB
522 E MAIN ST
MASCOUTAH, IL 62258-2240
Phone number: 618-566-0313
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Mailing Address
BREANNA LOGAN CLUBB
605 S BENTON ST
NEW ATHENS, IL 62264-1608
Phone number: 618-550-9969
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