Provider Demographics
NPI:1831422120
Name:SPROUL, JANICE FERN (CBT,CBS,)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:FERN
Last Name:SPROUL
Suffix:
Gender:F
Credentials:CBT,CBS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 NONPAREIL RD
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-9759
Mailing Address - Country:US
Mailing Address - Phone:541-430-1026
Mailing Address - Fax:541-459-9614
Practice Address - Street 1:3105 NONPAREIL RD
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479-9759
Practice Address - Country:US
Practice Address - Phone:541-430-1026
Practice Address - Fax:541-459-9614
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4013 BFOtherBIOFEEDBACK SPECIALIST