Provider Demographics
NPI:1043032741
Name:BROWN, KATHERINE ANNE (CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 OAKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9443
Mailing Address - Country:US
Mailing Address - Phone:907-351-7140
Mailing Address - Fax:
Practice Address - Street 1:391 OAKWOOD CIR
Practice Address - Street 2:
Practice Address - City:COAL VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61240-9443
Practice Address - Country:US
Practice Address - Phone:907-351-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61127878235Z00000X
IL146017537235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist