Provider Demographics
NPI:1396320164
Name:BROWN, MAYA JESSICA (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:JESSICA
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HOLLISTER LN APT 1141
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7292
Mailing Address - Country:US
Mailing Address - Phone:313-333-6264
Mailing Address - Fax:
Practice Address - Street 1:2108 LANDER RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4137
Practice Address - Country:US
Practice Address - Phone:313-333-6264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.1399-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOND.20201399-SPOtherOHIO SPEECH AND HEARING PROFESSIONALS BOARD