Healthcare Provider Details

I. General information

NPI: 1770507220
Provider Name (Legal Business Name): KERRY K BROWN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAIN ST W
CANNON FALLS MN
55009-2044
US

IV. Provider business mailing address

621 GROVE ST N
CANNON FALLS MN
55009-1626
US

V. Phone/Fax

Practice location:
  • Phone: 507-263-3344
  • Fax:
Mailing address:
  • Phone: 651-353-0813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP 4375
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: