MEDICARE: DENISE SPROUSE HARRISON M.ED.,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	SA1994	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518013713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE SPROUSE HARRISON M.ED.,CCC/SLP

Provider Business Mailing Address
First Line	:	36006 VIA GRAN
Second Line	:
City	:	GRAND ISLAND
State	:	FL
Zip	:	32735-9625
Country	:	US
Telephone Number	:	352-483-1181
Fax Number	:	352-483-1181

Provider Business Practice Location Address
First Line	:	36006 VIA GRAN
Second Line	:
City	:	GRAND ISLAND
State	:	FL
Zip	:	32735-9625
Country	:	US
Telephone Number	:	352-483-1181
Fax Number	:	352-483-1181

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

Provider Enumeration Date	:	01/28/2007
Last Update Date	:	02/09/2011

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Directions to “ DENISE SPROUSE HARRISON M.ED.,CCC/SLP” Practice Location

Language	Start Address	Practice Location

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