MEDICARE: SPROUT SPEECH THERAPY LLC

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

General Provider Information

NPI Number	:	1033041751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPROUT SPEECH THERAPY LLC

Provider Business Mailing Address
First Line	:	1315 S MAIN ST
Second Line	:
City	:	MARYVILLE
State	:	MO
Zip	:	64468-2644
Country	:	US
Telephone Number	:	660-254-2310
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 S MAIN ST
Second Line	:
City	:	MARYVILLE
State	:	MO
Zip	:	64468-2644
Country	:	US
Telephone Number	:	660-254-2310
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/SPEECH LANGUAGE PATH
Name	:	HALLEY SHURVINGTON
Credential	:	M.S., CCC-SLP
Telephone Number	:	660-254-2310

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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Directions to “SPROUT SPEECH THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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