Provider Demographics
NPI:1790250397
Name:SPROUTED ROOTS THERAPY & WELLNESS, LLC
Entity Type:Organization
Organization Name:SPROUTED ROOTS THERAPY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:971-266-3590
Mailing Address - Street 1:2127 NW IRVING ST APT 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5242
Mailing Address - Country:US
Mailing Address - Phone:971-266-3590
Mailing Address - Fax:
Practice Address - Street 1:2127 NW IRVING ST APT 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5242
Practice Address - Country:US
Practice Address - Phone:971-266-3590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty