MEDICARE: JENNELL MARIE BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C.2002657	OH
2	101YP2500X	Professional Counselor	E.2203210	OH

General Provider Information

NPI Number	:	1134784341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNELL MARIE BROWN

Provider Business Mailing Address
First Line	:	4405 N HOLLAND SYLVANIA RD STE 102
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3533
Country	:	US
Telephone Number	:	567-777-2808
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 N HOLLAND SYLVANIA RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3529
Country	:	US
Telephone Number	:	567-777-2808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	06/01/2026

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