Provider Demographics
NPI:1689989402
Name:BROWN, ROBERT HENRY JR (MA,CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:HENRY
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4576 BERRY RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1547
Mailing Address - Country:US
Mailing Address - Phone:716-672-8135
Mailing Address - Fax:
Practice Address - Street 1:4576 BERRY RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1547
Practice Address - Country:US
Practice Address - Phone:716-672-8135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007861-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist