Provider Demographics
NPI:1831555374
Name:BROWN, ELIZABETH CAMPBELL (SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CAMPBELL
Last Name:BROWN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MORGAN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1222 S PATTERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2684
Mailing Address - Country:US
Mailing Address - Phone:937-496-2622
Mailing Address - Fax:
Practice Address - Street 1:1222 S PATTERSON BLVD STE 400
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2642
Practice Address - Country:US
Practice Address - Phone:937-496-2620
Practice Address - Fax:937-424-8518
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169056235Z00000X
KYSLPINP00222362235Z00000X
OHSP.12923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist