Provider Demographics
NPI:1750554234
Name:BROWN, SCOTT R (PA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15435 W 134TH PL
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6135
Mailing Address - Country:US
Mailing Address - Phone:913-780-0030
Mailing Address - Fax:913-782-2924
Practice Address - Street 1:15435 W 134TH PL
Practice Address - Street 2:SUITE # 101
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6135
Practice Address - Country:US
Practice Address - Phone:913-780-0030
Practice Address - Fax:913-782-2924
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002025184235Z00000X
KS1741235Z00000X
KS15-01870363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2002025184OtherMO SLP LICENSE
KS1741OtherKS SLP LICENSE