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General NPI Number Information
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NPI Number | 1235504655
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Entity Type | Individual
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Provider Name | OLIVIA TORRES SPRAUER PSYD
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Gender | Female
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 833 KENMOOR AVE SE STE A
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2390
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Country | US
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Telephone | 616-227-3423
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Fax | 616-965-3968
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Provider Business Mailing Address
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Address Line | 3235 NE 45TH AVE
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City | PORTLAND
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State | OR
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Zip | 97213-1143
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Country | US
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Telephone | 503-773-4140
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Fax | 503-427-7884
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301018177
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301018177
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License Number State | MI
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