Healthcare Provider Details

I. General information

NPI: 1619889268
Provider Name (Legal Business Name): MINDY J BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA J BROWN

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

3400 N MAIN ST
SOQUEL CA
95073-2212
US

IV. Provider business mailing address

115 TAYLOR RD
BEN LOMOND CA
95005-9446
US

V. Phone/Fax

Practice location:
  • Phone: 831-464-5650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14445418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: