Provider Demographics
NPI:1669035598
Name:BROWN, KELSEY RENEE DEANA
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:RENEE DEANA
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 1:3160 JUNIPER RDG APT A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5784
Mailing Address - Country:US
Mailing Address - Phone:541-816-1635
Mailing Address - Fax:
Practice Address - Street 1:534 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7118
Practice Address - Country:US
Practice Address - Phone:541-200-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes172V00000XOther Service ProvidersCommunity Health Worker