Provider Demographics
NPI:1003036336
Name:SOUTHARD, ALAN BRETTE (MS SLP)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:BRETTE
Last Name:SOUTHARD
Suffix:
Gender:M
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-4712
Mailing Address - Country:US
Mailing Address - Phone:806-385-7283
Mailing Address - Fax:
Practice Address - Street 1:1400 MAIN
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:TX
Practice Address - Zip Code:79312
Practice Address - Country:US
Practice Address - Phone:806-246-3483
Practice Address - Fax:806-246-3483
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist