Provider Demographics
NPI:1700022738
Name:BROWN, MARCIE VIVIAN (MA)
Entity Type:Individual
Prefix:MS
First Name:MARCIE
Middle Name:VIVIAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 WOODSTONE DR W
Mailing Address - Street 2:116
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2584
Mailing Address - Country:US
Mailing Address - Phone:734-395-7908
Mailing Address - Fax:
Practice Address - Street 1:3400 WOODSTONE DR W APT 116
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2500
Practice Address - Country:US
Practice Address - Phone:734-395-7908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000299231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist