Provider Demographics
NPI:1538519541
Name:JESSICA BROWN
Entity Type:Organization
Organization Name:JESSICA BROWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EARLY INTERVENTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-809-7298
Mailing Address - Street 1:8792 GRASMERE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-7153
Mailing Address - Country:US
Mailing Address - Phone:662-809-7298
Mailing Address - Fax:
Practice Address - Street 1:8792 GRASMERE CT
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-7153
Practice Address - Country:US
Practice Address - Phone:662-809-7298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency