Provider Demographics
NPI:1679219745
Name:SPARKMAN, ZACK H
Entity Type:Individual
Prefix:
First Name:ZACK
Middle Name:H
Last Name:SPARKMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 WHITETAIL XING
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8639
Mailing Address - Country:US
Mailing Address - Phone:630-800-7083
Mailing Address - Fax:
Practice Address - Street 1:223 WHITETAIL XING
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8639
Practice Address - Country:US
Practice Address - Phone:630-800-7083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017666101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional