Provider Demographics
NPI:1659759165
Name:BROWN, MARY KATHERINE KEMP (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY KATHERINE
Middle Name:KEMP
Last Name:BROWN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 KEMP RD
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-5727
Mailing Address - Country:US
Mailing Address - Phone:912-539-4232
Mailing Address - Fax:
Practice Address - Street 1:618 BOWENS MILL RD SW
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3926
Practice Address - Country:US
Practice Address - Phone:912-539-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-16
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist