Provider Demographics
NPI:1033576319
Name:BROWN, JODIE VAUGHN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:VAUGHN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 SIENNA DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1001
Mailing Address - Country:US
Mailing Address - Phone:678-761-2023
Mailing Address - Fax:
Practice Address - Street 1:785 SIENNA DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1001
Practice Address - Country:US
Practice Address - Phone:678-761-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist