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General NPI Number Information
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NPI Number | 1679054126
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Entity Type | Individual
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Provider Name | EMILIE HOPE BROUSSARD X MSCCCSLP
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Gender | Female
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 709 W 5TH ST
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City | BONHAM
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State | TX
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Zip | 75418-4209
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Country | US
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Telephone | 903-583-8551
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Fax | 903-583-9456
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Provider Business Mailing Address
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Address Line | 709 W 5TH ST
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City | BONHAM
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State | TX
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Zip | 75418-4209
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Country | US
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Telephone | 309-583-8551
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Fax | 903-583-9456
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 104592
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License Number State | TX
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