Provider Demographics
NPI:1710256755
Name:SPRAGUE, JOANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 GARDEN CITY DR
Mailing Address - Street 2:
Mailing Address - City:MATTYDALE
Mailing Address - State:NY
Mailing Address - Zip Code:13211-1416
Mailing Address - Country:US
Mailing Address - Phone:315-455-6782
Mailing Address - Fax:
Practice Address - Street 1:530 STOLP AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-1207
Practice Address - Country:US
Practice Address - Phone:315-435-4520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007883-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist