Provider Demographics
NPI:1437412616
Name:BROUSSARD, PAULA SIMONE (MCD, CCC, SLP)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:SIMONE
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:MCD, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 WEST LOOP S STE 206
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2438
Mailing Address - Country:US
Mailing Address - Phone:713-660-8232
Mailing Address - Fax:713-660-0473
Practice Address - Street 1:5959 WEST LOOP SOUTH
Practice Address - Street 2:SUITE 206
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2438
Practice Address - Country:US
Practice Address - Phone:713-660-8232
Practice Address - Fax:713-660-0473
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18468235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist