Healthcare Provider Details

I. General information

NPI: 1609604347
Provider Name (Legal Business Name): NICHOLE SPROWSO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 E COMMERCIAL ST STE 208
SPRINGFIELD MO
65803-2961
US

IV. Provider business mailing address

2883 S ROCHELLE AVE
SPRINGFIELD MO
65804-3953
US

V. Phone/Fax

Practice location:
  • Phone: 970-208-7791
  • Fax:
Mailing address:
  • Phone: 980-208-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024029659
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: