Individual
IAN CIZERLE-BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 E CHESTNUT ST, INDEPENDENCE, KS 67301-3132
(620) 331-0057
Mailing address
1601 W 4TH ST, COFFEYVILLE, KS 67337-3333
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2356
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200636930A
—
KS
Enumeration date
02/15/2010
Last updated
03/10/2014
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