Provider Demographics
NPI:1174194450
Name:BROUSSARD, GABRIELLE MARIE (MA, SLP)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MARIE
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13611 SKINNER RD STE 250
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4692
Mailing Address - Country:US
Mailing Address - Phone:832-593-6767
Mailing Address - Fax:
Practice Address - Street 1:1110 ENCLAVE PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1606
Practice Address - Country:US
Practice Address - Phone:832-593-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist