Provider Demographics
NPI:1821551177
Name:BROWN, CASSANDRA KAY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:KAY
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:KAY
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CF-SLP
Mailing Address - Street 1:2761 WASHINGTON DRIVE SUITE 111
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069
Mailing Address - Country:US
Mailing Address - Phone:405-990-1694
Mailing Address - Fax:405-493-0717
Practice Address - Street 1:2761 WASHINGTON DRIVE SUITE 111
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069
Practice Address - Country:US
Practice Address - Phone:405-990-1694
Practice Address - Fax:405-493-0717
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK235Z00000X
14201637235Z00000X
OK5297235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200906440Medicaid