Provider Demographics
NPI:1689276552
Name:BROCK, SARAH JORDAN (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:JORDAN
Last Name:BROCK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:4800 S HIGHWAY 377
Mailing Address - Street 2:
Mailing Address - City:KRUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-5032
Mailing Address - Country:US
Mailing Address - Phone:940-488-5110
Mailing Address - Fax:
Practice Address - Street 1:4800 S HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:KRUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:76227-5032
Practice Address - Country:US
Practice Address - Phone:940-488-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist