Healthcare Provider Details

I. General information

NPI: 1871400564
Provider Name (Legal Business Name): STACI JEAN BROWN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 PLUM ST
GRAYLING MI
49738-1437
US

IV. Provider business mailing address

901 VALLEYVIEW CT
GAYLORD MI
49735-8256
US

V. Phone/Fax

Practice location:
  • Phone: 989-614-1569
  • Fax:
Mailing address:
  • Phone: 989-614-1569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7153000216
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: