Healthcare Provider Details

I. General information

NPI: 1134784341
Provider Name (Legal Business Name): JENNELL MARIE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 N HOLLAND SYLVANIA RD
TOLEDO OH
43623-3529
US

IV. Provider business mailing address

4405 N HOLLAND SYLVANIA RD STE 102
TOLEDO OH
43623-3533
US

V. Phone/Fax

Practice location:
  • Phone: 567-777-2808
  • Fax:
Mailing address:
  • Phone: 567-777-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2002657
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2203210
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: