MEDICARE: JULIA SPONG

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	1006473	MN

General Provider Information

NPI Number	:	1992652994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA SPONG

Provider Business Mailing Address
First Line	:	3720 LINWOOD RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-1546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3720 LINWOOD RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-1546
Country	:	US
Telephone Number	:	803-606-2825
Fax Number	:

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

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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Directions to “ JULIA SPONG ” Practice Location

Language	Start Address	Practice Location

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