Basic Information
| Provider Information | |||||||||
| NPI: | 1558675165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 413 OSPREY LAKES CIR | ||||||||
| Address2: | |||||||||
| City: | CHULUOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327666656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073595952 | ||||||||
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| Practice Location | |||||||||
| Address1: | 602 VONDERBURG DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136531149 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2010 | ||||||||
| LastUpdateDate: | 09/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA17391 | FL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SA 10540 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.