Provider Demographics
NPI:1124361480
Name:THE BROWN CLINIC P.C.
Entity Type:Organization
Organization Name:THE BROWN CLINIC P.C.
Other - Org Name:THE BROWN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:1618-222-7277
Mailing Address - Street 1:4460 N ILLINOIS ST STE 7
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1899
Mailing Address - Country:US
Mailing Address - Phone:618-222-7277
Mailing Address - Fax:618-222-7305
Practice Address - Street 1:4460 N ILLINOIS ST STE 7
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1899
Practice Address - Country:US
Practice Address - Phone:618-222-7277
Practice Address - Fax:618-222-7305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149014435305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization