Healthcare Provider Details

I. General information

NPI: 1235389453
Provider Name (Legal Business Name): HEATHER SPRAGUE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 HUMPHREY RD
SCOTTSVILLE NY
14546-9604
US

IV. Provider business mailing address

437 HUMPHREY RD
SCOTTSVILLE NY
14546-9604
US

V. Phone/Fax

Practice location:
  • Phone: 585-889-8137
  • Fax:
Mailing address:
  • Phone: 585-889-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number014005
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: