MEDICARE: MR. JESSE RYAN SPROUSE

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1386499184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JESSE RYAN SPROUSE

Provider Business Mailing Address
First Line	:	1324 WILLOWDALE AVE
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-5148
Country	:	US
Telephone Number	:	937-361-9391
Fax Number	:	937-918-7161

Provider Business Practice Location Address
First Line	:	1324 WILLOWDALE AVE
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-5148
Country	:	US
Telephone Number	:	937-361-9391
Fax Number	:	937-918-7161

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

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	04/23/2024

Similar Medicare Providers

1346609732 — GRACEWORKS ENHANCED LIVING
Practice Location Address:

1300 WILLOWDALE AVE
DAYTON, OH
45429-5148

Practice Phone: 937-949-9547
Practice Fax:

1235839242 — DR. MEGAN ALISE CLARK PHARMD
Practice Location Address:

3535 SOUTHERN BLVD
KETTERING, OH
45429-1221

Practice Phone: 937-298-3399
Practice Fax:

1164354817 — BUTLER COUNTY COMMUNITY HEALTH CONSORTIUM, INC.
Practice Location Address:

3301 SHROYER RD
KETTERING, OH
45429-2635

Practice Phone: 513-454-1111
Practice Fax: 513-737-1592

1164354841 — BUTLER COUNTY COMMUNITY HEALTH CONSORTIUM, INC.
Practice Location Address:

4001 ACKERMAN BLVD
KETTERING, OH
45429-4609

Practice Phone: 513-454-1111
Practice Fax: 513-737-1592

1740112432 — BUTLER COUNTY COMMUNITY HEALTH CONSORTIUM, INC.
Practice Location Address:

1349 E STROOP RD
KETTERING, OH
45429-4925

Practice Phone: 513-454-1111
Practice Fax: 513-737-1592

1730011453 — BUTLER COUNTY COMMUNITY HEALTH CONSORTIUM, INC.
Practice Location Address:

3775 SHROYER RD
KETTERING, OH
45429-2735

Practice Phone: 513-454-1111
Practice Fax: 513-737-1592

Directions to “ MR. JESSE RYAN SPROUSE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.