Provider Demographics
NPI:1083009724
Name:BROWN, KANDACE LEAH (BS)
Entity Type:Individual
Prefix:
First Name:KANDACE
Middle Name:LEAH
Last Name:BROWN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S 28TH ST APT 11
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3754
Mailing Address - Country:US
Mailing Address - Phone:580-799-3024
Mailing Address - Fax:
Practice Address - Street 1:416 N 4TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-2412
Practice Address - Country:US
Practice Address - Phone:580-799-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical