=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114121233
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHONDA MARIE BROWN PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 PENNSYLVANIA AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63133-1325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-512-7800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1036 PLEASANT MEADOW DR
-----------------------------------------------------
City | LAKE SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63367-2614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-322-6643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 2001014376
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------