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General NPI Number Information
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NPI Number | 1114642857
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Entity Type | Individual
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Provider Name | MADISSON RENAE SPROUSE MSW-LISW
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Gender | Female
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 2434 RICHMILLER LN
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City | BELPRE
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State | OH
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Zip | 45714-1075
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Country | US
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Telephone | 304-485-0791
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 188
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-0188
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Country | US
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Telephone | 740-773-4366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW082216357
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2308707
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License Number State | OH
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