Provider Demographics
NPI:1023151214
Name:BROWN, REBECCA SUSAN (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUSAN
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 1:88 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-8130
Mailing Address - Country:US
Mailing Address - Phone:724-986-8899
Mailing Address - Fax:
Practice Address - Street 1:413 W MONTGOMERY XRD STE 102
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4321
Practice Address - Country:US
Practice Address - Phone:912-354-4474
Practice Address - Fax:912-354-4443
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSLP-0723OtherWV LICENSE
KY3611OtherSLP LICENSE
12044736OtherASHA
VA2202003791OtherVA LICENSE
WV3810003127Medicaid
GASLP007547OtherGA BOARD FOR SPEECH-LANGUAGE PATHOLOGY
GA003134946AMedicaid