Provider Demographics
NPI:1568412070
Name:BROWN, HEATHER R (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 NOTRE DAME DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8735
Mailing Address - Country:US
Mailing Address - Phone:585-703-5355
Mailing Address - Fax:
Practice Address - Street 1:1057 E HENRIETTA RD
Practice Address - Street 2:SUITE 500
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2635
Practice Address - Country:US
Practice Address - Phone:585-427-2977
Practice Address - Fax:585-427-7410
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6901235Z00000X
NY013025-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12070863OtherASHA NUMBER
NC7412395Medicaid