Healthcare Provider Details

I. General information

NPI: 1770981656
Provider Name (Legal Business Name): AUTUMN BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S HEBRON AVE
EVANSVILLE IN
47714-4048
US

IV. Provider business mailing address

515 BAYOU ST
VINCENNES IN
47591-1034
US

V. Phone/Fax

Practice location:
  • Phone: 812-471-1776
  • Fax: 812-469-2000
Mailing address:
  • Phone: 812-886-6800
  • Fax: 812-886-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34008003A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: