Provider Demographics
NPI:1407077688
Name:BROWN, KERI ANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:ANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:ANNE
Other - Last Name:BORDELON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:550 FILES RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-5436
Mailing Address - Country:US
Mailing Address - Phone:318-773-0163
Mailing Address - Fax:
Practice Address - Street 1:126 POGUE LN
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7727
Practice Address - Country:US
Practice Address - Phone:501-760-8628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4709235Z00000X
ARSP2570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178814721Medicaid