Healthcare Provider Details

I. General information

NPI: 1891288221
Provider Name (Legal Business Name): MAGGIE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5029 KELVINDALE RD APT A
LOVES PARK IL
61111-1549
US

IV. Provider business mailing address

5029 KELVINDALE RD APT A
LOVES PARK IL
61111-1549
US

V. Phone/Fax

Practice location:
  • Phone: 815-543-7716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: