Basic Information
| Provider Information | |||||||||
| NPI: | 1689065757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARBER-BROWN | ||||||||
| FirstName: | ASPEN | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | QASP-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16941 N EAGLE RIVER LOOP RD | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995777824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077265330 | ||||||||
| FaxNumber: | 9077265366 | ||||||||
| Practice Location | |||||||||
| Address1: | 7905 L ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681271732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029093030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2015 | ||||||||
| LastUpdateDate: | 02/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 103K00000X | 8974 | NE | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.