MEDICARE: NICOLE D SPRUILL SLP-CCC

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	7706	NC

General Provider Information

NPI Number	:	1568650703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE D SPRUILL SLP-CCC

Provider Business Mailing Address
First Line	:	8740 AVEBURY DR APT H
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-3154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8740 AVEBURY DR APT H
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-3154
Country	:	US
Telephone Number	:	704-494-0740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	08/20/2008

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