Healthcare Provider Details

I. General information

NPI: 1053216002
Provider Name (Legal Business Name): MAKAYLLA RAEANNE SPRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 BUCKINGHAM ST
SAINT JOSEPH MO
64506-3605
US

IV. Provider business mailing address

808 MANSFIELD RD
SAINT JOSEPH MO
64504-1734
US

V. Phone/Fax

Practice location:
  • Phone: 816-469-5162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: