Provider Demographics
NPI:1780323816
Name:BROWN, ANGELA THOMAS (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:THOMAS
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 LAKE GLEN TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4090
Mailing Address - Country:US
Mailing Address - Phone:817-453-3530
Mailing Address - Fax:
Practice Address - Street 1:1016 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1745
Practice Address - Country:US
Practice Address - Phone:817-299-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist