Provider Demographics
NPI:1497923403
Name:SPRAGUE, LINDA L (CCC-A)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:L
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20416 GLENMORE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1040
Mailing Address - Country:US
Mailing Address - Phone:313-255-1465
Mailing Address - Fax:313-966-4678
Practice Address - Street 1:20416 GLENMORE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1040
Practice Address - Country:US
Practice Address - Phone:313-255-1465
Practice Address - Fax:313-966-4678
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILS000316231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist