Provider Demographics
NPI:1881259430
Name:HAMMONS, BREANNA RENEE (MSE, BCBA)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:RENEE
Last Name:HAMMONS
Suffix:
Gender:F
Credentials:MSE, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 RIVER OAKS
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-1887
Mailing Address - Country:US
Mailing Address - Phone:501-213-5088
Mailing Address - Fax:
Practice Address - Street 1:1028 RIVER OAKS
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-1887
Practice Address - Country:US
Practice Address - Phone:501-213-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1-16-22317103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst