Provider Demographics
NPI:1013125152
Name:JOHNSON BROWN, CINDY D (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:D
Last Name:JOHNSON BROWN
Suffix:
Gender:F
Credentials: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 295
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:FL
Mailing Address - Zip Code:32463-0295
Mailing Address - Country:US
Mailing Address - Phone:407-625-5111
Mailing Address - Fax:
Practice Address - Street 1:2102B MUD HILL RD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-3874
Practice Address - Country:US
Practice Address - Phone:407-625-5111
Practice Address - Fax:850-635-0299
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8630235Z00000X
FLSA 8630235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty