Individual
JENNIFER LEE SPROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
919 S CENTRAL AVE, FAIRBORN, OH 45324-3804
(937) 878-4614
Mailing address
1819 FLESHER AVE, KETTERING, OH 45420-2916
(937) 902-4065
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-69978
OH
Other
Enumeration date
02/25/2019
Last updated
02/25/2019
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