MEDICARE: KIMATHA L SPRATLING LLMSW

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	1041C0700X	Clinical Social Worker	6801116047	MI

General Provider Information

NPI Number	:	1154908465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMATHA L SPRATLING LLMSW

Provider Business Mailing Address
First Line	:	1504 MERRILL AVE
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-3530
Country	:	US
Telephone Number	:	248-949-7429
Fax Number	:

Provider Business Practice Location Address
First Line	:	26211 CENTRAL PARK BLVD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-4107
Country	:	US
Telephone Number	:	248-949-7429
Fax Number	:

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

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	03/26/2026

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