Provider Demographics
NPI:1457779449
Name:BROWN, KELLY (MS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 ADAMS ST
Mailing Address - Street 2:SUITE A-335
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-4335
Mailing Address - Country:US
Mailing Address - Phone:951-637-7374
Mailing Address - Fax:951-824-7511
Practice Address - Street 1:2900 ADAMS ST
Practice Address - Street 2:SUITE A-335
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-4335
Practice Address - Country:US
Practice Address - Phone:951-637-7374
Practice Address - Fax:951-824-7511
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist