Provider Demographics
NPI:1518013713
Name:HARRISON, DENISE SPROUSE (MED,CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:SPROUSE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MED,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36006 VIA GRAN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735-9625
Mailing Address - Country:US
Mailing Address - Phone:352-483-1181
Mailing Address - Fax:352-483-1181
Practice Address - Street 1:36006 VIA GRAN
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32735-9625
Practice Address - Country:US
Practice Address - Phone:352-483-1181
Practice Address - Fax:352-483-1181
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1994235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880181900Medicaid