MEDICARE: KELLY BROWN M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP11014	CA

General Provider Information

NPI Number	:	1457779449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BROWN M.S.

Provider Business Mailing Address
First Line	:	2900 ADAMS ST
Second Line	:	SUITE A-335
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-4335
Country	:	US
Telephone Number	:	951-637-7374
Fax Number	:	951-824-7511

Provider Business Practice Location Address
First Line	:	2900 ADAMS ST
Second Line	:	SUITE A-335
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-4335
Country	:	US
Telephone Number	:	951-637-7374
Fax Number	:	951-824-7511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	04/07/2014

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Directions to “ KELLY BROWN M.S.” Practice Location

Language	Start Address	Practice Location

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