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General NPI Number Information
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NPI Number | 1366200974
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Entity Type | Individual
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Provider Name | TRACY BROWN PSY.S., NCSP
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Gender | Female
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Dates
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Enumeration Date | 03/08/2024
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 43274 COUNTY HIGHWAY 53
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City | NEW YORK MILLS
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State | MN
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Zip | 56567-9364
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Country | US
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Telephone | 907-252-2139
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Fax |
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Provider Business Mailing Address
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Address Line | 43274 COUNTY HIGHWAY 53
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City | NEW YORK MILLS
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State | MN
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Zip | 56567-9364
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Country | US
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Telephone | 907-252-2139
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 445195
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License Number State | MN
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