Provider Demographics
NPI:1497375406
Name:SPROUTING SEEDS THERAPY, LLC
Entity Type:Organization
Organization Name:SPROUTING SEEDS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:KRYSTAL
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:914-810-3475
Mailing Address - Street 1:547 NORTH AVE # 166
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2601
Mailing Address - Country:US
Mailing Address - Phone:914-810-3475
Mailing Address - Fax:
Practice Address - Street 1:547 NORTH AVE # 166
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-2601
Practice Address - Country:US
Practice Address - Phone:914-810-3475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech