Provider Demographics
NPI:1881044907
Name:BROWN, JILL SUZANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
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 1:7905 OMEGA CT
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1533
Mailing Address - Country:US
Mailing Address - Phone:410-458-0633
Mailing Address - Fax:
Practice Address - Street 1:7905 OMEGA CT
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21087-1533
Practice Address - Country:US
Practice Address - Phone:410-458-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02254235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist