Healthcare Provider Details

I. General information

NPI: 1073082954
Provider Name (Legal Business Name): DEANNA MARIE SPORLEDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 KATY DR
MARYVILLE MO
64468-1103
US

IV. Provider business mailing address

611 KATY DR
MARYVILLE MO
64468-1103
US

V. Phone/Fax

Practice location:
  • Phone: 573-246-0500
  • Fax: 573-246-0515
Mailing address:
  • Phone: 573-246-0500
  • Fax: 573-246-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018040819
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: