Provider Demographics
NPI:1689276552
Name:BROCK, SARAH JORDAN (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:JORDAN
Last Name:BROCK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:4601 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4603
Mailing Address - Country:US
Mailing Address - Phone:325-793-3537
Mailing Address - Fax:325-793-3587
Practice Address - Street 1:4601 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4603
Practice Address - Country:US
Practice Address - Phone:325-793-3537
Practice Address - Fax:325-793-3587
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109404OtherSPEECH
TX109404Medicaid