Provider Demographics
NPI:1194957522
Name:WEBER-BROWN, WILLIAM LESLIE (BS, BCC, LADC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LESLIE
Last Name:WEBER-BROWN
Suffix:
Gender:M
Credentials:BS, BCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4637
Mailing Address - Country:US
Mailing Address - Phone:320-492-7609
Mailing Address - Fax:320-259-0791
Practice Address - Street 1:227 10TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4637
Practice Address - Country:US
Practice Address - Phone:320-492-7609
Practice Address - Fax:320-259-0791
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302691101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)