Healthcare Provider Details

I. General information

NPI: 1497254973
Provider Name (Legal Business Name): SIERRA MARIE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11939 MANCHESTER RD # 162
DES PERES MO
63131-4502
US

IV. Provider business mailing address

15 N 12TH ST
BELLEVILLE IL
62220-1001
US

V. Phone/Fax

Practice location:
  • Phone: 314-626-0306
  • Fax:
Mailing address:
  • Phone: 636-524-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: