Active NPI
Suzanne W. Sprague
- Speech-Language Pathologist
- Russellville, AR
National Provider Identifier
1396987640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP#P8199
- Practice address
- 1200 S Elmira Ave
Russellville, AR 72802-9646 - Phone
- (479) 968-7118
- Fax
- (479) 968-8628
- NPI assigned
- Apr 1, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP#P8199 | AR | Primary |
Addresses
Primary practice location
1200 S Elmira Ave
Russellville, AR 72802-9646
Mailing address
PO Drawer 2109
Russellville, AR 72811
Phone (479) 967-2322
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 176388721 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP#P8199 | AR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673308800000",
"number": "1396987640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO DRAWER 2109",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "72811",
"telephone_number": "479-967-2322",
"fax_number": "479-967-2876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 S ELMIRA AVE",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728029646",
"telephone_number": "479-968-7118",
"fax_number": "479-968-8628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPRAGUE",
"first_name": "SUZANNE",
"middle_name": "W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-01",
"last_updated": "2023-01-10",
"certification_date": "2023-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AR",
"license": "SP#P8199",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "176388721",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.