Provider Demographics
NPI:1356938526
Name:BROWN, CARLY ALEXANDRA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ALEXANDRA
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:ALEXANDRA
Other - Last Name:DONOFRIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:21 TOPAZ CIR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9674
Mailing Address - Country:US
Mailing Address - Phone:330-506-3375
Mailing Address - Fax:
Practice Address - Street 1:7320 N PALMYRA RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9709
Practice Address - Country:US
Practice Address - Phone:330-506-3375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist