MEDICARE: KENNEDY RENEE 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	103K00000X	Behavior Analyst	1-26-86944	OR

General Provider Information

NPI Number	:	1376139857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNEDY RENEE BROWN

Provider Business Mailing Address
First Line	:	4819 SW HAMILTON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97221-3032
Country	:	US
Telephone Number	:	989-395-2925
Fax Number	:

Provider Business Practice Location Address
First Line	:	9320 SW BARBUR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-5437
Country	:	US
Telephone Number	:	877-264-6747
Fax Number	:

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

Provider Enumeration Date	:	12/18/2020
Last Update Date	:	04/08/2026

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