Provider Demographics
NPI:1871670562
Name:BROWN, ANDREA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
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 1:4474 WESTON RD
Mailing Address - Street 2:MB #214
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3195
Mailing Address - Country:US
Mailing Address - Phone:954-385-8560
Mailing Address - Fax:954-385-9505
Practice Address - Street 1:4474 WESTON RD
Practice Address - Street 2:MB #214
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-3195
Practice Address - Country:US
Practice Address - Phone:954-385-8560
Practice Address - Fax:954-385-9505
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA322627316AMedicaid