Provider Demographics
NPI:1831103142
Name:JEFFORDS-BROWN, KAREN (MA, LP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:JEFFORDS-BROWN
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1630
Mailing Address - Country:US
Mailing Address - Phone:612-840-4138
Mailing Address - Fax:
Practice Address - Street 1:1928 BERKELEY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1630
Practice Address - Country:US
Practice Address - Phone:612-840-4138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1793103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN446750700Medicaid