MEDICARE: MRS. MICKY JO BROWN MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4426	KS

General Provider Information

NPI Number	:	1073820213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICKY JO BROWN MS, CCC-SLP

Provider Business Mailing Address
First Line	:	423 N FRANKLIN ST
Second Line	:
City	:	FORT SCOTT
State	:	KS
Zip	:	66701-1766
Country	:	US
Telephone Number	:	918-384-8835
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 E WALL ST
Second Line	:
City	:	FORT SCOTT
State	:	KS
Zip	:	66701-1422
Country	:	US
Telephone Number	:	918-384-8835
Fax Number	:	620-390-3262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	03/17/2023

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