Doctor Name: | MR. DIETRICH MARK BROWNE |
NPI Number: | 1710304720 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA,CCC-SLP |
License Number: | SA12818 |
Business Practice Address: | 1301 W Eau Gallie Blvd Suite 105 Melbourne, FL - 329355390 |
Business Phone Number: | 3214216992 |
Business Fax Number: | 3214216993 |
Mailing Address: | 1301 W Eau Gallie Blvd, Suite 105 MELBOURNE |
State: | FL |
Postal Code: | 329355390 |
Phone Number: | 3214216992 |
Fax Number: | 3214216993 |
NPI Enumeration Date: | 03/27/2014 |
NPI Last Update Date: | 03/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA12818 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |