Provider Demographics
NPI:1538525100
Name:BROWN, BRITTANY DAWN-BONTON
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DAWN-BONTON
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 1:1000 CHINABERRY DR STE 900
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2455
Mailing Address - Country:US
Mailing Address - Phone:318-459-6795
Mailing Address - Fax:
Practice Address - Street 1:1100 S 3RD ST STE B&C
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4930
Practice Address - Country:US
Practice Address - Phone:337-238-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASC958436-3171400000X
LA171M00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171400000XOther Service ProvidersHealth & Wellness Coach
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1679507412OtherNPI
LA1544761Medicaid