Provider Demographics
NPI:1508187279
Name:BROWN, JANELLE THEREGG
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:THEREGG
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 1:254 LEFFERTS AVE
Mailing Address - Street 2:BASEMENT APT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4115
Mailing Address - Country:US
Mailing Address - Phone:202-280-9236
Mailing Address - Fax:
Practice Address - Street 1:254 LEFFERTS AVE
Practice Address - Street 2:BASEMENT APT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4115
Practice Address - Country:US
Practice Address - Phone:202-280-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist