Provider Demographics
NPI:1538205273
Name:BROWN, BRYN A (MA, CCC-SLP,COM)
Entity type:Individual
Prefix:MRS
First Name:BRYN
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, CCC-SLP,COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JOHN MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25755-0003
Mailing Address - Country:US
Mailing Address - Phone:304-696-3641
Mailing Address - Fax:
Practice Address - Street 1:1 JOHN MARSHALL DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-5885
Practice Address - Country:US
Practice Address - Phone:304-696-3641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0809235Z00000X
WVSLP-0803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7401171000Medicaid