Provider Demographics
NPI:1669927778
Name:BROWN, KARISSA B
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:B
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:B
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1610 E. SUNSHINE STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804
Mailing Address - Country:US
Mailing Address - Phone:417-861-7477
Mailing Address - Fax:
Practice Address - Street 1:1610 E SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1313
Practice Address - Country:US
Practice Address - Phone:417-523-7500
Practice Address - Fax:417-523-7595
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MO2015016450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist