Provider Demographics
NPI:1700164498
Name:BROWN, RODNEY DREW
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:DREW
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 1:1217 N BLACKWELDER AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5549
Mailing Address - Country:US
Mailing Address - Phone:424-242-9315
Mailing Address - Fax:
Practice Address - Street 1:1217 N BLACKWELDER AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5549
Practice Address - Country:US
Practice Address - Phone:424-242-9315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst