Provider Demographics
NPI:1467922088
Name:ANDERSON, BREANNA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9355 W STOCKTON BLVD
Mailing Address - Street 2:UNIT 100
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624
Mailing Address - Country:US
Mailing Address - Phone:916-683-1109
Mailing Address - Fax:
Practice Address - Street 1:9355 W STOCKTON BLVD
Practice Address - Street 2:UNIT 100
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-683-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-22-13473106E00000X
106S00000X
CA1-22-62349103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician