Provider Demographics
NPI:1497358410
Name:BROWN, STEPHANIE (SPED, LD, TSVI, COMS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:SPED, LD, TSVI, COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 LADYS LN
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2320
Mailing Address - Country:US
Mailing Address - Phone:864-934-8880
Mailing Address - Fax:
Practice Address - Street 1:801 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:SC
Practice Address - Zip Code:29697-1061
Practice Address - Country:US
Practice Address - Phone:864-934-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1104973577Medicaid