MEDICARE: DR. HEATHER SPRAGUE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	014005	NY

General Provider Information

NPI Number	:	1235389453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER SPRAGUE PH.D.

Provider Business Mailing Address
First Line	:	437 HUMPHREY RD
Second Line	:
City	:	SCOTTSVILLE
State	:	NY
Zip	:	14546-9604
Country	:	US
Telephone Number	:	585-889-8137
Fax Number	:

Provider Business Practice Location Address
First Line	:	437 HUMPHREY RD
Second Line	:
City	:	SCOTTSVILLE
State	:	NY
Zip	:	14546-9604
Country	:	US
Telephone Number	:	585-889-8137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	09/24/2008

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