Provider Demographics
NPI:1770507220
Name:BROWN, KERRY K (PSYD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:K
Last Name:BROWN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 GROVE ST N
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-1626
Mailing Address - Country:US
Mailing Address - Phone:651-353-0813
Mailing Address - Fax:
Practice Address - Street 1:401 MAIN ST W
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-2044
Practice Address - Country:US
Practice Address - Phone:507-263-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4375103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN116482OtherHEALTH PARTNERS
MN2443480OtherAMERICA'S PPO
MN170233OtherU-CARE
MN11572753OtherCAQH
MN2026310OtherBEHAVIORAL HEALTHCARE PRO
MN314P3BROtherBCBS