Provider Demographics
NPI:1780735092
Name:BROWN, MADELINE GERRITS (SCD,CCC-SP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:GERRITS
Last Name:BROWN
Suffix:
Gender:F
Credentials:SCD,CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5942 N CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-6509
Mailing Address - Country:US
Mailing Address - Phone:352-795-5833
Mailing Address - Fax:
Practice Address - Street 1:7655 W GULF TO LAKE HWY STE 11
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7910
Practice Address - Country:US
Practice Address - Phone:352-795-4114
Practice Address - Fax:352-563-2438
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880660800Medicaid