Healthcare Provider Details

I. General information

NPI: 1881504801
Provider Name (Legal Business Name): AMBER D BROWN SP 17406
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13715 S CASTLE RD
MANTECA CA
95336-8742
US

IV. Provider business mailing address

13715 S CASTLE RD
MANTECA CA
95336-8742
US

V. Phone/Fax

Practice location:
  • Phone: 209-679-8053
  • Fax:
Mailing address:
  • Phone: 209-679-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: