Provider Demographics
NPI:1629319900
Name:THE SPRUILL STUDIO FOR SPEECH AND VOICE, INC.
Entity Type:Organization
Organization Name:THE SPRUILL STUDIO FOR SPEECH AND VOICE, INC.
Other - Org Name:SPRUILL'S SPEECH AND LANGUAGE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRUILL
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC-SLP
Authorized Official - Phone:704-464-0464
Mailing Address - Street 1:1228 BRIDGEFORD DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4328
Mailing Address - Country:US
Mailing Address - Phone:704-464-0464
Mailing Address - Fax:866-636-4063
Practice Address - Street 1:1228 BRIDGEFORD DR NW
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4328
Practice Address - Country:US
Practice Address - Phone:704-464-0464
Practice Address - Fax:866-636-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7706252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200523Medicaid