Provider Demographics
NPI:1578946638
Name:COLLIER, BRANWEN ROSE (BCBA)
Entity Type:Individual
Prefix:
First Name:BRANWEN
Middle Name:ROSE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:BRANWEN
Other - Middle Name:
Other - Last Name:MENDEL-GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3700 AMER BAY LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515
Mailing Address - Country:US
Mailing Address - Phone:907-349-4222
Mailing Address - Fax:907-349-4223
Practice Address - Street 1:2836 KIMBERLIE COURT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-349-4222
Practice Address - Fax:907-349-4223
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1-15-18557103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst