Provider Demographics
NPI:1679054126
Name:BROUSSARD, EMILIE HOPE X (MSCCCSLP)
Entity type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:HOPE
Last Name:BROUSSARD
Suffix:X
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4209
Mailing Address - Country:US
Mailing Address - Phone:309-583-8551
Mailing Address - Fax:903-583-9456
Practice Address - Street 1:709 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4209
Practice Address - Country:US
Practice Address - Phone:903-583-8551
Practice Address - Fax:903-583-9456
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist