Basic Information
| Provider Information | |||||||||
| NPI: | 1225648546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | OLIVIA | ||||||||
| MiddleName: | MARY ALEXANDRA | ||||||||
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| Credential: | M.S. CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1126 TOWN AND FOUR PARKWAY DR | ||||||||
| Address2: | |||||||||
| City: | CREVE COEUR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026775919 | ||||||||
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| Practice Location | |||||||||
| Address1: | 950 FRANCIS PL STE 115 | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631052465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146441978 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2020 | ||||||||
| LastUpdateDate: | 08/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2020022907 | MO | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.