Provider Demographics
NPI:1457710832
Name:BROWN, CAROL ANNETTE (MS SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANNETTE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13087 N COUNTY ROAD 349
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-6663
Mailing Address - Country:US
Mailing Address - Phone:386-688-7703
Mailing Address - Fax:
Practice Address - Street 1:13087 N COUNTY ROAD 349
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-6663
Practice Address - Country:US
Practice Address - Phone:386-688-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 22672355S0801X
252Y00000X
FLSZ8305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA16634OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH
FLSZ8305OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH