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General NPI Number Information
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NPI Number | 1003757006
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Entity Type | Organization
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Legal Business Name | SPROUT SPEECH THERAPY LLC
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Dates
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Enumeration Date | 04/03/2026
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Last Update Date | 04/03/2026
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Provider Practice Location Address
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Address Line | 18025 30TH PL N
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City | PLYMOUTH
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State | MN
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Zip | 55447-1636
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Country | US
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Telephone | 763-200-6367
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Fax | 651-369-5540
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Provider Business Mailing Address
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Address Line | 18025 30TH PL N
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City | PLYMOUTH
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State | MN
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Zip | 55447-1636
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Country | US
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Telephone | 763-200-6367
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Fax | 651-369-5540
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | ALAINA KAGANOVICH
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Credential | M.A., CCC-SLP
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Telephone | 763-200-6367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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