Healthcare Provider Details

I. General information

NPI: 1497192165
Provider Name (Legal Business Name): JESSICA ASHLEY BROWN MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 WAYMONT CT
LAKE MARY FL
32746-6744
US

IV. Provider business mailing address

295 WAYMONT CT
LAKE MARY FL
32746-6744
US

V. Phone/Fax

Practice location:
  • Phone: 407-322-3962
  • Fax: 407-323-1614
Mailing address:
  • Phone: 407-322-3962
  • Fax: 407-323-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA12174
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: