Provider Demographics
NPI:1093961617
Name:BROWN, GLORIA LOUISE (MCD CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:LOUISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MCD CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 19084
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6600
Mailing Address - Country:US
Mailing Address - Phone:870-802-4267
Mailing Address - Fax:870-802-4267
Practice Address - Street 1:1606 PINE GROVE LN
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:AR
Practice Address - Zip Code:72432-9304
Practice Address - Country:US
Practice Address - Phone:870-578-5426
Practice Address - Fax:870-578-6005
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist