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NPI Code Detail

MEDICARE: JASMINE ENISE SPRUILL CCC-SLP

MEDICARE: JASMINE ENISE SPRUILL CCC-SLP
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
1235Z00000XSpeech-Language Pathologist2393AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1515-30839OTHERALBLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1801808415
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMINE ENISE SPRUILL CCC-SLP
Provider Business Mailing Address
First Line : 110 REBECCA PINES DR
Second Line :
City : MADISON
State : AL
Zip : 35758-8295
Country : US
Telephone Number : 256-489-4144
Fax Number : 256-650-5041
Provider Business Practice Location Address
First Line : 245 CAHABA VALLEY PKWY
Second Line : SUITE 200
City : PELHAM
State : AL
Zip : 35124-2216
Country : US
Telephone Number : 205-942-6820
Fax Number : 205-942-5627
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2006
Last Update Date : 07/08/2007

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Directions to “ JASMINE ENISE SPRUILL CCC-SLP” Practice Location

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