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General NPI Number Information
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NPI Number | 1215450564
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Entity Type | Individual
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Provider Name | HAILY BROOKE OWEN BCBA
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Gender | Female
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/19/2017
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Provider Practice Location Address
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Address Line | 101 S DUBOIS ST
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City | TALLASSEE
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State | AL
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Zip | 36078-1405
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Country | US
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Telephone | 334-707-6861
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Fax | 334-252-1282
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Provider Business Mailing Address
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Address Line | 143 NORTH AVE
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City | AUBURN
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State | AL
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Zip | 36830-3029
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Country | US
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Telephone | 334-252-0025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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