MEDICARE: MRS. JESSIE LEE SPRAGUE LCSW

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	1041C0700X	Clinical Social Worker	R055822-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000590264001	OTHER	NY	BC/BS OF WNY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326060757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSIE LEE SPRAGUE LCSW

Provider Business Mailing Address
First Line	:	202 N BARRY ST
Second Line	:
City	:	OLEAN
State	:	NY
Zip	:	14760-2723
Country	:	US
Telephone Number	:	716-373-0139
Fax Number	:	585-593-7071

Provider Business Practice Location Address
First Line	:	4220 BOLIVAR RD
Second Line	:
City	:	WELLSVILLE
State	:	NY
Zip	:	14895-9332
Country	:	US
Telephone Number	:	585-593-6300
Fax Number	:	585-593-7071

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	02/08/2026

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