Provider Demographics
NPI:1386230886
Name:BROWN, ELIZABETH EDITH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EDITH
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5816 SANDSHELL CIR E APT 11101
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-7016
Mailing Address - Country:US
Mailing Address - Phone:786-371-6779
Mailing Address - Fax:
Practice Address - Street 1:5816 SANDSHELL CIR E APT 11101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-7016
Practice Address - Country:US
Practice Address - Phone:786-371-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX417102355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant