Provider Demographics
NPI:1619229960
Name:BROWN, DAMARIS F
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:F
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 S STATE ST
Mailing Address - Street 2:STE 2
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4438
Mailing Address - Country:US
Mailing Address - Phone:507-238-2390
Mailing Address - Fax:507-238-2399
Practice Address - Street 1:757 S STATE ST
Practice Address - Street 2:STE 2
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4438
Practice Address - Country:US
Practice Address - Phone:507-238-2390
Practice Address - Fax:507-238-2399
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2719237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist