Provider Demographics
NPI:1609604347
Name:SPROWSO, NICHOLE (LCSW)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:SPROWSO
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3097 N DICKERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-1267
Mailing Address - Country:US
Mailing Address - Phone:980-208-7791
Mailing Address - Fax:
Practice Address - Street 1:334 E COMMERCIAL ST STE 208
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-2961
Practice Address - Country:US
Practice Address - Phone:970-208-7791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240296591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical