Healthcare Provider Details

I. General information

NPI: 1477111524
Provider Name (Legal Business Name): MADISON CARROLL SPRANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CURRIE HALL PKWY
KENT OH
44240-4312
US

IV. Provider business mailing address

190 CURRIE HALL PKWY
KENT OH
44240-4312
US

V. Phone/Fax

Practice location:
  • Phone: 330-673-5812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2505506
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: