Provider Demographics
NPI:1194032961
Name:SORRELLS, LATRICHIELLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LATRICHIELLE
Middle Name:
Last Name:SORRELLS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 CIMARRON PARK LOOP STE D
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2854
Mailing Address - Country:US
Mailing Address - Phone:512-295-2273
Mailing Address - Fax:512-295-2280
Practice Address - Street 1:181 CIMARRON PARK LOOP STE D
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-2854
Practice Address - Country:US
Practice Address - Phone:512-295-2273
Practice Address - Fax:512-295-2280
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106216235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist