Provider Demographics
NPI:1316539364
Name:SPRADLEY, JENNA LYNNE (ACSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNNE
Last Name:SPRADLEY
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1693 MISSION DR STE C208
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2686
Mailing Address - Country:US
Mailing Address - Phone:805-708-6146
Mailing Address - Fax:
Practice Address - Street 1:1693 MISSION DR STE C208
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2686
Practice Address - Country:US
Practice Address - Phone:805-708-6146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA777851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical