Provider Demographics
NPI:1013209352
Name:BROWN, KERI R (PHD)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:BLACK EARTH
Mailing Address - State:WI
Mailing Address - Zip Code:53515-0322
Mailing Address - Country:US
Mailing Address - Phone:608-370-2345
Mailing Address - Fax:
Practice Address - Street 1:4752 OLD INDIAN TRL
Practice Address - Street 2:
Practice Address - City:BLACK EARTH
Practice Address - State:WI
Practice Address - Zip Code:53515-9745
Practice Address - Country:US
Practice Address - Phone:419-989-5532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34949103TC0700X
WI3512-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical