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General NPI Number Information
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NPI Number | 1326731662
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Entity Type | Individual
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Provider Name | GRACE BEVERLY BROWN
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Gender | Female
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Dates
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Enumeration Date | 06/01/2023
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 165 W NETHERWOOD ST
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City | OREGON
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State | WI
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Zip | 53575-1107
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Country | US
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Telephone | 608-835-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 137 25TH AVE
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City | MONROE
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State | WI
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Zip | 53566-1250
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Country | US
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Telephone | 608-558-8217
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 7399-226
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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