Healthcare Provider Details

I. General information

NPI: 1477057750
Provider Name (Legal Business Name): MELISA LEE BROWN CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MARTIN LUTHER KING DR
CINCINNATI OH
45220
US

IV. Provider business mailing address

311 MARTIN LUTHER KING DR
CINCINNATI OH
45220
US

V. Phone/Fax

Practice location:
  • Phone: 513-332-0350
  • Fax: 513-332-0368
Mailing address:
  • Phone: 513-475-5300
  • Fax: 513-332-0368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number140972
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: