Healthcare Provider Details

I. General information

NPI: 1649190745
Provider Name (Legal Business Name): TRUDY-ANN ALEXANDRIA BROWN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 W PINE AVE
MERIDIAN ID
83642-2281
US

IV. Provider business mailing address

39 W PINE AVE
MERIDIAN ID
83642-2281
US

V. Phone/Fax

Practice location:
  • Phone: 208-803-5339
  • Fax: 815-642-8485
Mailing address:
  • Phone: 208-803-5339
  • Fax: 815-642-8485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6071294
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: