Provider Demographics
NPI:1184760282
Name:BROWN, LISA NELSON (CCC-A)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:NELSON
Last Name:BROWN
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 EASTERN PKWY
Mailing Address - Street 2:BUILDING B TREATMENT CENTER
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1566
Mailing Address - Country:US
Mailing Address - Phone:502-595-4459
Mailing Address - Fax:502-595-3403
Practice Address - Street 1:982 EASTERN PKWY
Practice Address - Street 2:BUILDING B TREATMENT CENTER
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1566
Practice Address - Country:US
Practice Address - Phone:502-595-4459
Practice Address - Fax:502-595-3403
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0225231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist