Provider Demographics
NPI:1104510684
Name:BROWN, KRISTOPHER MATTHEW (AUD)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:MATTHEW
Last Name:BROWN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 SHOAL CREEK BLVD APT 107
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1001
Mailing Address - Country:US
Mailing Address - Phone:512-773-0241
Mailing Address - Fax:
Practice Address - Street 1:2220 LAKEWAY BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5136
Practice Address - Country:US
Practice Address - Phone:866-525-3929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81516231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist