MEDICARE: KEVIN SCOTT BROWN LMSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	00076	IA
2	104100000X	Social Worker	007136	IA

General Provider Information

NPI Number	:	1477709228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN SCOTT BROWN LMSW

Provider Business Mailing Address
First Line	:	973 73RD ST, STE 24
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1024
Country	:	US
Telephone Number	:	515-200-7979
Fax Number	:	515-276-9057

Provider Business Practice Location Address
First Line	:	974 73RD ST
Second Line	:	SUITE 24
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1024
Country	:	US
Telephone Number	:	515-200-7979
Fax Number	:	515-267-9057

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

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	02/13/2017

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