Provider Demographics
NPI:1790049633
Name:BROWN, ELIZABETH C (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSP, 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:PO BOX 762
Mailing Address - Street 2:SPEECH-LANGUAGE PATHOLOGY SERVICES, INC.
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-0762
Mailing Address - Country:US
Mailing Address - Phone:910-914-6100
Mailing Address - Fax:910-914-6095
Practice Address - Street 1:109 E WYCHE ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3429
Practice Address - Country:US
Practice Address - Phone:910-914-6100
Practice Address - Fax:910-914-6095
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821148180OtherORGANIZATION NPI
NC7470724Medicaid