Provider Demographics
NPI:1659155752
Name:BROWN, MIA KAYE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:KAYE
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 1:804 W JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4159
Mailing Address - Country:US
Mailing Address - Phone:479-750-8812
Mailing Address - Fax:
Practice Address - Street 1:804 W JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4159
Practice Address - Country:US
Practice Address - Phone:573-729-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023032656235Z00000X
AR202875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist