MEDICARE: DR. BRANDY DAWN BROWN PSYD, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	LP 5204	MN

General Provider Information

NPI Number	:	1780914507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDY DAWN BROWN PSYD, LP

Provider Business Mailing Address
First Line	:	416 HERITAGE PL
Second Line	:
City	:	FARIBAULT
State	:	MN
Zip	:	55021-5248
Country	:	US
Telephone Number	:	507-332-2002
Fax Number	:	507-332-1972

Provider Business Practice Location Address
First Line	:	416 HERITAGE PL
Second Line	:
City	:	FARIBAULT
State	:	MN
Zip	:	55021-5248
Country	:	US
Telephone Number	:	507-332-2002
Fax Number	:	507-332-1972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	12/29/2009

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