=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891287983
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIENNE WHITAKER SPRAGUE SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2018
-----------------------------------------------------
Last Update Date | 06/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17100 E SHEA BLVD STE 600
-----------------------------------------------------
City | FOUNTAIN HILLS
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85268-6663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-381-9048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 749 9TH ST UNIT 254
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27705-1065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-696-3006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------