Provider Demographics
NPI:1689471658
Name:BROWN, KASSIE JO (HAD)
Entity type:Individual
Prefix:
First Name:KASSIE
Middle Name:JO
Last Name:BROWN
Suffix:
Gender:
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 LOG CABIN DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-6318
Mailing Address - Country:US
Mailing Address - Phone:478-788-0087
Mailing Address - Fax:
Practice Address - Street 1:4701 LOG CABIN DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-6318
Practice Address - Country:US
Practice Address - Phone:478-788-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS001115237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist