MEDICARE: BRIANNE WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	B10204121	OR

General Provider Information

NPI Number	:	1841713666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNE WILLIAMS

Provider Business Mailing Address
First Line	:	130 SMITHBURY ST APT 3
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-7954
Country	:	US
Telephone Number	:	808-346-6510
Fax Number	:

Provider Business Practice Location Address
First Line	:	2368 CRATER LAKE AVE STE 102
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-5006
Country	:	US
Telephone Number	:	541-480-2570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	06/05/2020

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Directions to “ BRIANNE WILLIAMS ” Practice Location

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