MEDICARE: JENNIFER SUSAN BROWN MA

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	103TC1900X	Counseling Psychologist	LPCC.0014819	CO

General Provider Information

NPI Number	:	1194271346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SUSAN BROWN MA

Provider Business Mailing Address
First Line	:	1370 BERGLIND RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3105
Country	:	US
Telephone Number	:	719-641-0009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1802 CHAPEL HILLS DR STE C
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3736
Country	:	US
Telephone Number	:	719-641-0009
Fax Number	:

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

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	12/10/2018

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