Provider Demographics
NPI:1114208808
Name:BROWN, NICOLE M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 GOODLETTE RD N
Mailing Address - Street 2:140
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5469
Mailing Address - Country:US
Mailing Address - Phone:239-434-9512
Mailing Address - Fax:
Practice Address - Street 1:671 GOODLETTE RD N
Practice Address - Street 2:140
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5469
Practice Address - Country:US
Practice Address - Phone:239-434-9512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11333235Z00000X
OHSP. 10086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist