Provider Demographics
NPI:1205008620
Name:BROWN, STEPHANIE LYNN (LPN CM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPN CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-8369
Mailing Address - Country:US
Mailing Address - Phone:405-799-8310
Mailing Address - Fax:405-799-8310
Practice Address - Street 1:1008 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-8369
Practice Address - Country:US
Practice Address - Phone:405-799-8310
Practice Address - Fax:405-799-8310
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL 0027546104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker