Provider Demographics
NPI:1861568875
Name:SPRAGUE, SANDRA JANE (MED)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JANE
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JANE
Other - Last Name:WILLITTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:2 WALL ST.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101
Mailing Address - Country:US
Mailing Address - Phone:603-668-4111
Mailing Address - Fax:603-628-7757
Practice Address - Street 1:9 BLODGET ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3598
Practice Address - Country:US
Practice Address - Phone:603-668-4111
Practice Address - Fax:603-628-7757
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health