Provider Demographics
NPI:1710337472
Name:BROWN, LANDON (SLP-INTERN)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:SLP-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1741
Mailing Address - Country:US
Mailing Address - Phone:806-353-3596
Mailing Address - Fax:806-353-4927
Practice Address - Street 1:720 S TYLER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-2313
Practice Address - Country:US
Practice Address - Phone:806-651-5106
Practice Address - Fax:806-651-5105
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112449235Z00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112449OtherSTATE BOARD OF EXAMINERS FOR SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY