Provider Demographics
NPI:1548805385
Name:SPARKMAN, REBECCA LOU (MA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOU
Last Name:SPARKMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 S CHECK ST STE 208
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8067
Mailing Address - Country:US
Mailing Address - Phone:907-521-8504
Mailing Address - Fax:
Practice Address - Street 1:1075 S CHECK ST STE 208
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8067
Practice Address - Country:US
Practice Address - Phone:907-521-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13530101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral