Provider Demographics
NPI:1861662736
Name:BROUSSARD SOROKWASZ, MEREDITH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:BROUSSARD SOROKWASZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10125 ANDRE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5933
Mailing Address - Country:US
Mailing Address - Phone:214-725-7991
Mailing Address - Fax:
Practice Address - Street 1:10125 ANDRE DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5933
Practice Address - Country:US
Practice Address - Phone:214-725-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist