Provider Demographics
NPI:1750634879
Name:PAGAN, SUREIMA (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUREIMA
Middle Name:
Last Name:PAGAN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19611 JACKSON BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4341
Mailing Address - Country:US
Mailing Address - Phone:936-314-1386
Mailing Address - Fax:
Practice Address - Street 1:500 SPRING HILL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-6023
Practice Address - Country:US
Practice Address - Phone:281-309-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001906235Z00000X
TX110408235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist