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General NPI Number Information
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NPI Number | 1972772077
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Entity Type | Individual
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Provider Name | KELLI BROUSSARD S.L.P.
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Gender | Female
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 711 W 38TH ST BLDG F2
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City | AUSTIN
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State | TX
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Zip | 78705
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Country | US
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Telephone | 512-755-5058
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Fax | 833-964-0174
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Provider Business Mailing Address
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Address Line | 11216 DELLA TORRE DR
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City | AUSTIN
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State | TX
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Zip | 78750-2810
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Country | US
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Telephone | 512-550-6857
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Fax |
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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 | 100265
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License Number State | TX
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