Provider Demographics
NPI:1932996121
Name:SPRADLIN, JESSIE
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:SPRADLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-4503
Mailing Address - Country:US
Mailing Address - Phone:918-219-6787
Mailing Address - Fax:
Practice Address - Street 1:2025 E 58TH ST N
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-4503
Practice Address - Country:US
Practice Address - Phone:918-219-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKM080587720103K00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst