Healthcare Provider Details

I. General information

NPI: 1881607844
Provider Name (Legal Business Name): SUSAN CECELIA BROWN M.A. L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 LAUREL ST
BRAINERD MN
56401-3586
US

IV. Provider business mailing address

7500 WISE RD
BRAINERD MN
56401-6004
US

V. Phone/Fax

Practice location:
  • Phone: 218-251-1554
  • Fax:
Mailing address:
  • Phone: 218-251-1554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1154
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1154
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1154
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: