Provider Demographics
NPI:1568453165
Name:BREAUX, PATRICIA SALOOM (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:SALOOM
Last Name:BREAUX
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:SALOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:13611 SKINNER RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1018
Mailing Address - Country:US
Mailing Address - Phone:832-593-6767
Mailing Address - Fax:832-593-6868
Practice Address - Street 1:13611 SKINNER RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1018
Practice Address - Country:US
Practice Address - Phone:832-593-6767
Practice Address - Fax:832-593-6868
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174180301Medicaid