Provider Demographics
NPI:1952789885
Name:BROWN, NATRECE NICKISHA (SLP)
Entity Type:Individual
Prefix:
First Name:NATRECE
Middle Name:NICKISHA
Last Name:BROWN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 S MERIDIAN APT Z102
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1642
Mailing Address - Country:US
Mailing Address - Phone:858-336-4376
Mailing Address - Fax:
Practice Address - Street 1:6220 S ALASKA ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1317
Practice Address - Country:US
Practice Address - Phone:253-476-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60026338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist