Provider Demographics
NPI:1457960023
Name:SPRAGUE, JASON ALLAN (LCPC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALLAN
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 FOXGLOVE DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2804
Mailing Address - Country:US
Mailing Address - Phone:630-248-0616
Mailing Address - Fax:
Practice Address - Street 1:1205 FOXGLOVE DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2804
Practice Address - Country:US
Practice Address - Phone:630-248-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011213101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional