Provider Demographics
NPI:1518128099
Name:BROWN, PAMELA MARIE
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 BUCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-3639
Mailing Address - Country:US
Mailing Address - Phone:313-207-9651
Mailing Address - Fax:313-905-4835
Practice Address - Street 1:1569 GREGORY AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-3509
Practice Address - Country:US
Practice Address - Phone:313-207-9651
Practice Address - Fax:313-905-4835
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 3747A0650X
MI3501003017237700000X
MI6803088663104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI71020000H21654OtherBCBSM