Healthcare Provider Details

I. General information

NPI: 1376014241
Provider Name (Legal Business Name): ANNIE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 E BURNETT AVE
LOUISVILLE KY
40217-1577
US

IV. Provider business mailing address

6107 STANNYE DR
LOUISVILLE KY
40222-6339
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-4631
  • Fax:
Mailing address:
  • Phone: 502-553-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: