Provider Demographics
NPI:1588232284
Name:SPRAGUE, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7566 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2813
Mailing Address - Country:US
Mailing Address - Phone:314-706-1842
Mailing Address - Fax:
Practice Address - Street 1:7566 CORNELL AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-2813
Practice Address - Country:US
Practice Address - Phone:314-706-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician