Provider Demographics
NPI:1306954862
Name:MAXWELL-BROWN, MARCIA ANN (CCC SLP)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:ANN
Last Name:MAXWELL-BROWN
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:113 CHAPEL ST
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043
Mailing Address - Country:US
Mailing Address - Phone:518-234-2479
Mailing Address - Fax:518-234-2479
Practice Address - Street 1:121 OPPORTUNITY DRIVE
Practice Address - Street 2:SCHOHARIE ARC
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157
Practice Address - Country:US
Practice Address - Phone:518-295-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003860-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist