Provider Demographics
NPI:1083117642
Name:BROWN, JULIE JORDAN (CCA)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:JORDAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:CCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 S 103RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4163
Mailing Address - Country:US
Mailing Address - Phone:414-543-1002
Mailing Address - Fax:414-543-0137
Practice Address - Street 1:3400 S 103RD ST STE 200
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4163
Practice Address - Country:US
Practice Address - Phone:414-543-1002
Practice Address - Fax:414-543-0137
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41653200Medicaid