Provider Demographics
NPI:1740341650
Name:BROWN, JODI ANN (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MS
Other - First Name:JODI
Other - Middle Name:ANN
Other - Last Name:PIERZCHALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5771 TIMBER RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235
Mailing Address - Country:US
Mailing Address - Phone:920-559-1148
Mailing Address - Fax:920-592-9320
Practice Address - Street 1:200 NORTH 7TH AVENUE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235
Practice Address - Country:US
Practice Address - Phone:920-743-6274
Practice Address - Fax:920-592-9320
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2150-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42788100Medicaid