Provider Demographics
NPI:1326656018
Name:SPROUTING ROOTS SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:SPROUTING ROOTS SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAEGAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BRANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:757-846-4926
Mailing Address - Street 1:320 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3730
Mailing Address - Country:US
Mailing Address - Phone:757-846-4926
Mailing Address - Fax:
Practice Address - Street 1:45 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-4011
Practice Address - Country:US
Practice Address - Phone:757-846-4926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-19
Last Update Date:2020-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty