MEDICARE: JESSICA 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1538519541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA BROWN

Provider Business Mailing Address
First Line	:	8792 GRASMERE CT
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-7153
Country	:	US
Telephone Number	:	662-809-7298
Fax Number	:

Provider Business Practice Location Address
First Line	:	8792 GRASMERE CT
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-7153
Country	:	US
Telephone Number	:	662-809-7298
Fax Number	:

Authorized Official
Title or Position	:	EARLY INTERVENTIONIST
Name	:	JESSICA BROWN
Credential	:
Telephone Number	:	662-809-7298

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	06/21/2016

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