Provider Demographics
NPI:1326788068
Name:BROWN, ADDY JANE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ADDY
Middle Name:JANE
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 1:380 W 22ND ST APT 515
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2073
Mailing Address - Country:US
Mailing Address - Phone:816-714-8870
Mailing Address - Fax:
Practice Address - Street 1:4200 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5054
Practice Address - Country:US
Practice Address - Phone:913-682-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4956235Z00000X
MO2020017832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist