Provider Demographics
NPI:1447793948
Name:SPARKMAN, KRISTIN (MSW, APSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:SPARKMAN
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2678
Mailing Address - Country:US
Mailing Address - Phone:920-729-2777
Mailing Address - Fax:920-729-9682
Practice Address - Street 1:211 N COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2678
Practice Address - Country:US
Practice Address - Phone:920-729-2777
Practice Address - Fax:920-729-9682
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126581171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator