Provider Demographics
NPI:1366251753
Name:BROWN, JOBEANNA
Entity type:Individual
Prefix:
First Name:JOBEANNA
Middle Name:
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 1:5655 S MICHIGAN AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1124
Mailing Address - Country:US
Mailing Address - Phone:573-318-1115
Mailing Address - Fax:
Practice Address - Street 1:5655 S MICHIGAN AVE
Practice Address - Street 2:APT 1F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1124
Practice Address - Country:US
Practice Address - Phone:573-318-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician