Provider Demographics
NPI:1700374790
Name:BROWN, BROOKELYN ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKELYN
Middle Name:ELIZABETH
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 1:5401 VOGEL RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7832
Mailing Address - Country:US
Mailing Address - Phone:812-477-5000
Mailing Address - Fax:812-477-5002
Practice Address - Street 1:9165 OTIS AVE STE 114
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2311
Practice Address - Country:US
Practice Address - Phone:812-477-5000
Practice Address - Fax:812-477-5002
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006532A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist