Provider Demographics
NPI:1952535940
Name:SORRELLS, ALICIA JENETTE (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:JENETTE
Last Name:SORRELLS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19100 W LAKE HOUSTON PKWY
Mailing Address - Street 2:#104
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-5138
Mailing Address - Country:US
Mailing Address - Phone:281-812-9519
Mailing Address - Fax:
Practice Address - Street 1:19100 W LAKE HOUSTON PKWY
Practice Address - Street 2:#104
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-5138
Practice Address - Country:US
Practice Address - Phone:281-812-9519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103730235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist