MEDICARE: MR. BENJAMIN RICHARD BROWN M.A. 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	SA 8330	FL
2	235Z00000X	Speech-Language Pathologist	SP 942	HI
3	235Z00000X	Speech-Language Pathologist	7069	MA

General Provider Information

NPI Number	:	1619185709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN RICHARD BROWN M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	1057 LUNDY CT
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-6115
Country	:	US
Telephone Number	:	407-304-6901
Fax Number	:

Provider Business Practice Location Address
First Line	:	1408 N WEST SHORE BLVD
Second Line	:	300
City	:	TAMPA
State	:	FL
Zip	:	33607-4525
Country	:	US
Telephone Number	:	407-304-6901
Fax Number	:

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

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. BENJAMIN RICHARD BROWN M.A. CCC-SLP” Practice Location

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