Provider Demographics
NPI:1538452156
Name:BROOMS, ALICIA NICOLE (MSCCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:NICOLE
Last Name:BROOMS
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WEST LOOP S
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3515
Mailing Address - Country:US
Mailing Address - Phone:713-965-9998
Mailing Address - Fax:713-965-9921
Practice Address - Street 1:2100 WEST LOOP S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3515
Practice Address - Country:US
Practice Address - Phone:713-965-9998
Practice Address - Fax:713-965-9921
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist