Provider Demographics
NPI:1922368273
Name:SPRAGUE, KIRSTIE LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTIE
Middle Name:LYNN
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 1:949 BROWNING LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5462
Mailing Address - Country:US
Mailing Address - Phone:916-408-8634
Mailing Address - Fax:
Practice Address - Street 1:949 BROWNING LN
Practice Address - Street 2:4600 47TH AVENUE, SUITE 111 SACRAMENTO CA 95824
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5462
Practice Address - Country:US
Practice Address - Phone:916-408-8634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28245104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker