Provider Demographics
NPI:1497192165
Name:BROWN, JESSICA ASHLEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ASHLEY
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 WAYMONT CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6744
Mailing Address - Country:US
Mailing Address - Phone:407-322-3962
Mailing Address - Fax:407-323-1614
Practice Address - Street 1:295 WAYMONT CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6744
Practice Address - Country:US
Practice Address - Phone:407-322-3962
Practice Address - Fax:407-323-1614
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist