Provider Demographics
NPI:1588811590
Name:SPRAGUE, TINA (LCSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3129
Mailing Address - Country:US
Mailing Address - Phone:630-421-8462
Mailing Address - Fax:
Practice Address - Street 1:4905 OLD ORCHARD CTR
Practice Address - Street 2:SUITE 435
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1458
Practice Address - Country:US
Practice Address - Phone:630-421-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150-011716104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker