Provider Demographics
NPI:1336483007
Name:SPRAUER, STACI CARROL (LMT)
Entity Type:Individual
Prefix:MS
First Name:STACI
Middle Name:CARROL
Last Name:SPRAUER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CINDY LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT ANGEL
Mailing Address - State:OR
Mailing Address - Zip Code:97362-9592
Mailing Address - Country:US
Mailing Address - Phone:541-948-2362
Mailing Address - Fax:
Practice Address - Street 1:405 CINDY LN
Practice Address - Street 2:
Practice Address - City:MOUNT ANGEL
Practice Address - State:OR
Practice Address - Zip Code:97362-9592
Practice Address - Country:US
Practice Address - Phone:541-948-2362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist