Breanna Logan Mank
Individual provider Active NPI School Psychologist · Red Bud, IL
NPI 1104547702 · NPPES record last updated Aug 25, 2026
Key facts
- NPI
- 1104547702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Psychologist 103TS0200X
- License
- 1383039 (IL)
- Practice address
- 1525 Locust St
Red Bud, IL 62278-1374 - Phone
- (618) 282-6251
- NPI assigned
- Sep 12, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 1383039 | IL | Yes |
Addresses
Primary practice location
1525 Locust St
Red Bud, IL 62278-1374
Mailing address
605 S Benton St
New Athens, IL 62264-1608
Phone (618) 550-9969
Other names
- Breanna Logan Clubb
Other providers in Red Bud, IL
- Jessica Liefer
- Maureen K Liefer
- Natalie N Liefer
- Lori R Trost DMD PC
- Jody K Lurk
- Laura L Meade
- Lindsey Renea Meeks
- Taylar Marie Mercille
- Gail Meyer
- Terri Milton
All providers in Red Bud, IL · School Psychologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.