Provider Demographics
NPI:1467990622
Name:BROWN, SUSAN LYN (LADC, LSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYN
Last Name:BROWN
Suffix:
Gender:F
Credentials:LADC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:SOLON SPRINGS
Mailing Address - State:WI
Mailing Address - Zip Code:54873-0298
Mailing Address - Country:US
Mailing Address - Phone:651-245-9648
Mailing Address - Fax:
Practice Address - Street 1:1614 W 3RD ST
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2086
Practice Address - Country:US
Practice Address - Phone:651-327-2770
Practice Address - Fax:651-327-2771
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301700101YA0400X
MN13727104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN301700OtherLADC LICENSE NUMBER