Provider Demographics
NPI:1881580777
Name:BROWN, CHERYL RENAY
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:RENAY
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 1:403 W STATE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6126
Mailing Address - Country:US
Mailing Address - Phone:360-612-3839
Mailing Address - Fax:360-637-9132
Practice Address - Street 1:403 W STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6126
Practice Address - Country:US
Practice Address - Phone:360-612-3839
Practice Address - Fax:360-637-9132
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWDL74N65C03B175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist