MEDICARE: SPROUT SPEECH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1497545693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPROUT SPEECH PLLC

Provider Business Mailing Address
First Line	:	6725 CLYDE ST APT 7B
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4013
Country	:	US
Telephone Number	:	718-757-5687
Fax Number	:

Provider Business Practice Location Address
First Line	:	6725 CLYDE ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4056
Country	:	US
Telephone Number	:	718-757-5687
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLY CHAN
Credential	:	CCC-SLP
Telephone Number	:	718-757-5687

Provider Enumeration Date	:	05/09/2025
Last Update Date	:	06/23/2025

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Directions to “SPROUT SPEECH PLLC ” Practice Location

Language	Start Address	Practice Location

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