Provider Demographics
NPI:1942999172
Name:BROADWELL, SAMMI GEANN RAE ESTRELLADO
Entity Type:Individual
Prefix:
First Name:SAMMI GEANN RAE
Middle Name:ESTRELLADO
Last Name:BROADWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14515 BRIAR FOREST DR APT 337
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2074
Mailing Address - Country:US
Mailing Address - Phone:346-527-3222
Mailing Address - Fax:
Practice Address - Street 1:14515 BRIAR FOREST DR APT 337
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-2074
Practice Address - Country:US
Practice Address - Phone:346-527-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX423432355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant