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General NPI Number Information
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NPI Number | 1588151146
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Entity Type | Organization
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Legal Business Name | LITTLE SPROUT SPEECH THERAPY, LLC
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 118 N PETERS RD STE 174
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City | KNOXVILLE
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State | TN
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Zip | 37923-4927
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Country | US
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Telephone | 318-381-5858
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Fax |
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Provider Business Mailing Address
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Address Line | 8913 CHIMNEY POINT DR
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City | KNOXVILLE
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State | TN
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Zip | 37922-1402
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Country | US
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Telephone | 318-381-5858
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MARY ENSMINGER LOOMIS
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Credential | MS, CCC-SLP
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Telephone | 318-381-5858
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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 | 6405
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License Number State | TN
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