MEDICARE: MRS. MELISSA B SPRUCE CCC-SLP

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	SA882	FL

General Provider Information

NPI Number	:	1295974947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA B SPRUCE CCC-SLP

Provider Business Mailing Address
First Line	:	5060 CHARDONNAY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4122
Country	:	US
Telephone Number	:	954-345-5824
Fax Number	:

Provider Business Practice Location Address
First Line	:	5060 CHARDONNAY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4122
Country	:	US
Telephone Number	:	954-345-5824
Fax Number	:

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

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	02/19/2009

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