Healthcare Provider Details

I. General information

NPI: 1306558747
Provider Name (Legal Business Name): KATHERINE R SPRAGG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 HAMILTON RD STE 4
WAPAKONETA OH
45895-1156
US

IV. Provider business mailing address

PO BOX 265
NEW BREMEN OH
45869-0265
US

V. Phone/Fax

Practice location:
  • Phone: 419-405-3508
  • Fax:
Mailing address:
  • Phone: 419-954-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE R SPRAGG
Title or Position: OWNER
Credential:
Phone: 419-954-8013