Provider Demographics
NPI:1134383300
Name:BROWN, COURTNEY S (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:S
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 1:7579 NW 79TH AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2872
Mailing Address - Country:US
Mailing Address - Phone:954-682-5475
Mailing Address - Fax:
Practice Address - Street 1:7579 NW 79TH AVE APT 106
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2872
Practice Address - Country:US
Practice Address - Phone:954-682-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10815235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001952800Medicaid