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General NPI Number Information
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NPI Number | 1447935895
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH EDUCATION SUPPORT
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 1260 LAKE BLVD WL-228
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City | DAVIS
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State | CA
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Zip | 95616-2614
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Country | US
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Telephone | 530-219-4309
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Fax |
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Provider Business Mailing Address
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Address Line | 1260 LAKE BLVD
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City | DAVIS
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State | CA
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Zip | 95616-2614
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Country | US
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Telephone | 530-219-4309
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROWAN E FOLEY
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Credential | LEP
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Telephone | 530-219-4309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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