Provider Demographics
NPI:1669044061
Name:BROWN, KAYLIN CIERRA
Entity Type:Individual
Prefix:
First Name:KAYLIN
Middle Name:CIERRA
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLIN
Other - Middle Name:
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2742 CAROLINA CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:SC
Mailing Address - Zip Code:29525-4402
Mailing Address - Country:US
Mailing Address - Phone:843-269-1084
Mailing Address - Fax:
Practice Address - Street 1:710 U.S. 401
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:843-479-6251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist