Provider Demographics
NPI:1427497874
Name:BROWN, SANDRA GAIL (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:GAIL
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 CHAUCER DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3630
Mailing Address - Country:US
Mailing Address - Phone:843-665-6694
Mailing Address - Fax:843-665-6694
Practice Address - Street 1:515 N CASHUA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-2003
Practice Address - Country:US
Practice Address - Phone:843-664-8156
Practice Address - Fax:843-664-8177
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist