Provider Demographics
NPI:1144804824
Name:VASSEL-SPARKS, KRISTINA
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:VASSEL-SPARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21120 MERIDIAN AVE E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8254
Mailing Address - Country:US
Mailing Address - Phone:253-285-2213
Mailing Address - Fax:253-627-8387
Practice Address - Street 1:21120 MERIDIAN AVE E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8254
Practice Address - Country:US
Practice Address - Phone:253-285-2213
Practice Address - Fax:253-627-8387
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical