Healthcare Provider Details

I. General information

NPI: 1639081292
Provider Name (Legal Business Name): ELIZABETH MICHELLE BROWNLEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13223 BLACK MOUNTAIN RD # 1508
SAN DIEGO CA
92129-2698
US

IV. Provider business mailing address

13223 BLACK MOUNTAIN RD # 1508
SAN DIEGO CA
92129-2698
US

V. Phone/Fax

Practice location:
  • Phone: 619-550-6049
  • Fax:
Mailing address:
  • Phone: 619-550-6049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: