Provider Demographics
NPI:1386835205
Name:SPRAGUE, ALISA MARIE (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:ALISA
Middle Name:MARIE
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:MS
Other - First Name:ALISA
Other - Middle Name:MARIE
Other - Last Name:COTYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 E VORIS ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1513
Mailing Address - Country:US
Mailing Address - Phone:216-701-7095
Mailing Address - Fax:
Practice Address - Street 1:111 E VORIS ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1513
Practice Address - Country:US
Practice Address - Phone:216-701-7095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00049601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical