=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578789152
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEA HAWKINS BRAWNER M.S., CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 LYNN LN
-----------------------------------------------------
City | HEBER SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72543-7761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-362-4184
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1260
-----------------------------------------------------
City | HEBER SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72543-1260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-362-4184
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP1696
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------