Provider Demographics
NPI:1750142303
Name:SPRATLING, BAILEY ADELAIDE (LMSW)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:ADELAIDE
Last Name:SPRATLING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 ANNE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-5236
Mailing Address - Country:US
Mailing Address - Phone:208-881-7786
Mailing Address - Fax:
Practice Address - Street 1:477 SHOUP AVE STE 205
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3658
Practice Address - Country:US
Practice Address - Phone:208-881-7786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor