Individual
JACQUELYN IRENE SPROUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
217 EMMITT AVE, WAVERLY, OH 45690
(740) 649-2222
Mailing address
1500 BLUE LICK RD, LONDONDERRY, OH 45647-9741
(740) 649-2222
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
08/15/2019
Last updated
08/15/2019
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