Provider Demographics
NPI:1114642857
Name:SPROUSE, MADISSON RENAE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MADISSON
Middle Name:RENAE
Last Name:SPROUSE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MADISSON
Other - Middle Name:RENAE
Other - Last Name:PERDUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2434 RICHMILLER LN
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1075
Mailing Address - Country:US
Mailing Address - Phone:304-485-0791
Mailing Address - Fax:
Practice Address - Street 1:2434 RICHMILLER LN
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1075
Practice Address - Country:US
Practice Address - Phone:304-485-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSW082216357104100000X
OHS.2308707104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker