Provider Demographics
NPI:1629288436
Name:SPRUNK, HOLLY SUZANNE (CCC-SP, CBIS)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:SUZANNE
Last Name:SPRUNK
Suffix:
Gender:F
Credentials:CCC-SP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 FREEPORT LN NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3775
Mailing Address - Country:US
Mailing Address - Phone:360-550-1863
Mailing Address - Fax:
Practice Address - Street 1:7035 FREEPORT LN NE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3775
Practice Address - Country:US
Practice Address - Phone:360-497-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist