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Organization
SPROUT PEDIATRIC SPEECH THERAPY INC
Active
Organization
SPROUT PEDIATRIC SPEECH THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLLETTE CUBBAGE M.A., CCC-SLP, CMT (CHIEF EXECUTIVE OFFICER)
(831) 471-7344
Entity
Organization
Contact information
Practice address
2042 BOBWHITE LN, SANTA CRUZ, CA 95065-1853
(408) 533-2339
Mailing address
9057 SOQUEL DRIVE, BUILDING A, SUITE CC, APTOS, CA 95003
(831) 471-7344
(831) 999-1131
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/24/2020
Last updated
05/22/2024
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