Healthcare Provider Details

I. General information

NPI: 1659865202
Provider Name (Legal Business Name): CAITLYN SAGE BROWN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 SEA LARK LN
NAVARRE FL
32566-7406
US

IV. Provider business mailing address

1762 SEA LARK LN
NAVARRE FL
32566-7406
US

V. Phone/Fax

Practice location:
  • Phone: 850-204-8030
  • Fax: 850-204-8031
Mailing address:
  • Phone: 850-204-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ8598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: