Provider Demographics
NPI:1295004620
Name:BROWN, JENNIFER TAMAR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:TAMAR
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 W 400 N APT 6
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-8437
Mailing Address - Country:US
Mailing Address - Phone:801-592-9113
Mailing Address - Fax:
Practice Address - Street 1:44 W 400 N APT 6
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-8437
Practice Address - Country:US
Practice Address - Phone:801-592-9113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7776169-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical