Provider Demographics
NPI:1194386649
Name:BROWN, MERRETT KAILTIN (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:MERRETT
Middle Name:KAILTIN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4805
Mailing Address - Country:US
Mailing Address - Phone:408-982-3340
Mailing Address - Fax:669-247-0974
Practice Address - Street 1:2020 FOREST AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4805
Practice Address - Country:US
Practice Address - Phone:408-982-3340
Practice Address - Fax:669-247-0974
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13481235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty