MEDICARE: JESSICA 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	22213	CA
2	235Z00000X	Speech-Language Pathologist	9791	FL
3	235Z00000X	Speech-Language Pathologist	012882	OR

General Provider Information

NPI Number	:	1124484803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BROWN MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1661 TEXAS CIR
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1661 TEXAS CIR
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2238
Country	:	US
Telephone Number	:	714-814-1979
Fax Number	:

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

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	01/11/2016

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Directions to “ JESSICA BROWN MS, CCC-SLP” Practice Location

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