Provider Demographics
NPI:1417412826
Name:SPROUL, TRACEY RAE (LSW)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:RAE
Last Name:SPROUL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 SAVOY AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2164
Mailing Address - Country:US
Mailing Address - Phone:330-396-8933
Mailing Address - Fax:
Practice Address - Street 1:70 N MILLER RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3766
Practice Address - Country:US
Practice Address - Phone:330-867-0066
Practice Address - Fax:330-867-0056
Is Sole Proprietor?:No
Enumeration Date:2019-02-10
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.014920104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker