Provider Demographics
NPI:1912938275
Name:SPRANKLE, ERIC (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:SPRANKLE
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 WARREN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5197
Mailing Address - Country:US
Mailing Address - Phone:507-389-5825
Mailing Address - Fax:
Practice Address - Street 1:1600 WARREN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5197
Practice Address - Country:US
Practice Address - Phone:507-389-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5466103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY184607OtherMEDICARE GROUP NUMBER
KY610661458OtherFEDERAL TAX ID NUMBER