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General NPI Number Information
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NPI Number | 1629450291
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Entity Type | Individual
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Provider Name | MS. BREEANNA HORTON
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Gender | Female
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 1414 MAIN ST
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City | MELROSE PARK
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State | IL
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Zip | 60160
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Country | US
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Telephone | 708-681-0073
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Fax |
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Provider Business Mailing Address
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Address Line | 2950 TENNYSON ST
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City | DENVER
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State | CO
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Zip | 80212-3029
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Country | US
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Telephone | 720-855-3246
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0001270
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License Number State | CO
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