Provider Demographics
NPI:1295192219
Name:BREAUX, MIA K (CCC, SLP)
Entity Type:Individual
Prefix:MISS
First Name:MIA
Middle Name:K
Last Name:BREAUX
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 1:5757 FLEWELLEN OAKS LN STE 604
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1800
Mailing Address - Country:US
Mailing Address - Phone:832-736-5253
Mailing Address - Fax:832-553-2519
Practice Address - Street 1:5757 FLEWELLEN OAKS LN STE 604
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-1800
Practice Address - Country:US
Practice Address - Phone:832-736-5253
Practice Address - Fax:832-553-2519
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist