Healthcare Provider Details

I. General information

NPI: 1912387978
Provider Name (Legal Business Name): LYNN DIANE BROWN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN DIANE FOOTE SLP

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 08/24/2026
Certification Date:
Deactivation Date: 11/23/2015
Reactivation Date: 08/24/2026

III. Provider practice location address

1000 BUSINESS CENTER CIR STE 105
NEWBURY PARK CA
91320-1235
US

IV. Provider business mailing address

1000 BUSINESS CENTER CIR STE 105
NEWBURY PARK CA
91320-1235
US

V. Phone/Fax

Practice location:
  • Phone: 818-262-7110
  • Fax:
Mailing address:
  • Phone: 818-262-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: