Provider Demographics
NPI:1528553518
Name:BROWN, DANA (SLP)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3776 LAVISTA RD STE 250
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5657
Mailing Address - Country:US
Mailing Address - Phone:478-298-4679
Mailing Address - Fax:833-232-1614
Practice Address - Street 1:3776 LAVISTA RD STE 250
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5657
Practice Address - Country:US
Practice Address - Phone:770-862-6447
Practice Address - Fax:833-232-1614
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP010126OtherSTATE LICENSE