MEDICARE: NICOLE 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1386053718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE BROWN

Provider Business Mailing Address
First Line	:	4105 SE INTERNATIONAL WAY
Second Line	:	SUITE 501
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-8855
Country	:	US
Telephone Number	:	503-496-3201
Fax Number	:

Provider Business Practice Location Address
First Line	:	4105 SE INTERNATIONAL WAY
Second Line	:	SUITE 501
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-8855
Country	:	US
Telephone Number	:	503-496-3201
Fax Number	:

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

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	08/11/2014

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Directions to “ NICOLE BROWN ” Practice Location

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