Provider Demographics
NPI:1558080119
Name:HENSON, BREANNA (BCBA)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:HENSON
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 1:3107 RIDGEWOOD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7758
Mailing Address - Country:US
Mailing Address - Phone:573-701-5236
Mailing Address - Fax:
Practice Address - Street 1:16375 PIERSIDE LN
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1600
Practice Address - Country:US
Practice Address - Phone:636-405-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst