Provider Demographics
NPI:1811017213
Name:BROWN, ANGELIA M (SLP)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 AMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7904
Mailing Address - Country:US
Mailing Address - Phone:601-497-1970
Mailing Address - Fax:
Practice Address - Street 1:6155 AMBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7904
Practice Address - Country:US
Practice Address - Phone:601-497-1970
Practice Address - Fax:601-497-1970
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist