Provider Demographics
NPI:1275723645
Name:SPARKS, ELAINE A (HUMAN SERVICE WORKER)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:A
Last Name:SPARKS
Suffix:
Gender:F
Credentials:HUMAN SERVICE WORKER
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:A
Other - Last Name:HOLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 BUSH ST
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-3805
Mailing Address - Country:US
Mailing Address - Phone:707-621-1664
Mailing Address - Fax:
Practice Address - Street 1:237 E GOBBI ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5551
Practice Address - Country:US
Practice Address - Phone:707-472-2922
Practice Address - Fax:707-462-1381
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator