Provider Demographics
NPI:1780675348
Name:BROWN, JANET LORI (MA CCC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LORI
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7177 BROCKTON AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2631
Mailing Address - Country:US
Mailing Address - Phone:951-684-5620
Mailing Address - Fax:951-684-5681
Practice Address - Street 1:7177 BROCKTON AVE
Practice Address - Street 2:STE 104
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2631
Practice Address - Country:US
Practice Address - Phone:951-684-5620
Practice Address - Fax:951-684-5681
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1493237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0014930Medicaid
CAZZZ572482OtherBLUE CROSS BLUE SHIELD
CAZZZ32183ZOtherBLUE CROSS BLUE SHIELD
CAZZZ572482OtherBLUE CROSS BLUE SHIELD