Provider Demographics
NPI:1497788483
Name:SPROUSE, BRADLEY J (HIS)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:J
Last Name:SPROUSE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 W PIKE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2649
Mailing Address - Country:US
Mailing Address - Phone:304-624-0530
Mailing Address - Fax:304-624-7091
Practice Address - Street 1:756 W PIKE ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2649
Practice Address - Country:US
Practice Address - Phone:304-624-0530
Practice Address - Fax:304-624-7091
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV826237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist