MEDICARE: MS. CONNIE BROWN M.S. CCC-SP

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	261QR0400X	Rehabilitation Clinic/Center	5736	CA
2	235Z00000X	Speech-Language Pathologist	5736	CA

General Provider Information

NPI Number	:	1578957635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONNIE BROWN M.S. CCC-SP

Provider Business Mailing Address
First Line	:	256 E HAMILTON AVE STE L
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-0237
Country	:	US
Telephone Number	:	408-370-9562
Fax Number	:	408-871-8930

Provider Business Practice Location Address
First Line	:	256 E HAMILTON AVE STE L
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-0237
Country	:	US
Telephone Number	:	408-370-9562
Fax Number	:	408-871-8930

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

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	11/03/2020

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