Healthcare Provider Details

I. General information

NPI: 1316860372
Provider Name (Legal Business Name): SUZANNE DAVIS BROWN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 GRANVILLE ST
GAHANNA OH
43230-2947
US

IV. Provider business mailing address

380 GRANVILLE ST
GAHANNA OH
43230-2947
US

V. Phone/Fax

Practice location:
  • Phone: 614-471-7065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.00105
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: