Provider Demographics
NPI:1770897407
Name:BROWN, MICHELLE A (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MEADOWVIEW LN
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-6386
Mailing Address - Country:US
Mailing Address - Phone:518-852-3237
Mailing Address - Fax:
Practice Address - Street 1:113 MEADOWVIEW LN
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-6386
Practice Address - Country:US
Practice Address - Phone:518-852-3237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist