Provider Demographics
NPI:1477766962
Name:SPARKS, JENNIFER BETH
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BETH
Last Name: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 1:153 PINE LN
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2820
Mailing Address - Country:US
Mailing Address - Phone:215-321-7918
Mailing Address - Fax:
Practice Address - Street 1:1 OXFORD VALLEY MALL
Practice Address - Street 2:SUITE 310
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-741-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist