Provider Demographics
NPI:1710387170
Name:SPAFFORD, BROOKE ELAINE (EDS)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ELAINE
Last Name:SPAFFORD
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-2442
Mailing Address - Country:US
Mailing Address - Phone:419-984-1055
Mailing Address - Fax:
Practice Address - Street 1:407 DECATUR ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-2442
Practice Address - Country:US
Practice Address - Phone:419-984-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3175659103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool