Provider Demographics
NPI:1033882766
Name:BROWN, SUSAN M (CRM, CADC-R)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:CRM, CADC-R
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 764
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-0764
Mailing Address - Country:US
Mailing Address - Phone:503-984-1979
Mailing Address - Fax:
Practice Address - Street 1:134 SE 5TH AVE STE C
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4095
Practice Address - Country:US
Practice Address - Phone:503-543-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20-CRM-164175T00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)