Healthcare Provider Details

I. General information

NPI: 1003487703
Provider Name (Legal Business Name): MS. AUTUMN RAE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 COBURN ST
AKRON OH
44311-1459
US

IV. Provider business mailing address

838 COBURN ST
AKRON OH
44311-1459
US

V. Phone/Fax

Practice location:
  • Phone: 330-315-3716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2304907
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: