Provider Demographics
NPI:1477223402
Name:SPRENKEL, MELISSA SIERRA MICHELLE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SIERRA MICHELLE
Last Name:SPRENKEL
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 1:12623 NE 183RD ST APT 1212
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-9328
Mailing Address - Country:US
Mailing Address - Phone:925-978-3982
Mailing Address - Fax:
Practice Address - Street 1:11415 NE 128TH ST STE 40
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6315
Practice Address - Country:US
Practice Address - Phone:425-307-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA04640805OtherKAISER