Provider Demographics
NPI:1518095116
Name:BROWN, LAILA AUDREY (MSC(A))
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:AUDREY
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSC(A)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2841
Mailing Address - Country:US
Mailing Address - Phone:260-710-2013
Mailing Address - Fax:630-541-5318
Practice Address - Street 1:4600 MAIN ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2841
Practice Address - Country:US
Practice Address - Phone:260-710-2013
Practice Address - Fax:630-541-5318
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002233088OtherBLUE CROSS BLUE SHIELD #