Provider Demographics
NPI:1053013508
Name:SPRAFKE, JAYNE DEANE (LCSW)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:DEANE
Last Name:SPRAFKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAYNE
Other - Middle Name:DEANE
Other - Last Name:SHALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6502 SUMMIT CV
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84317-9411
Mailing Address - Country:US
Mailing Address - Phone:858-531-8080
Mailing Address - Fax:
Practice Address - Street 1:5929 FASHION POINT DR STE 130
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4683
Practice Address - Country:US
Practice Address - Phone:801-781-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT894171935011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical