Provider Demographics
NPI:1780780692
Name:SPARLING, SOPHIE K (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:SOPHIE
Middle Name:K
Last Name:SPARLING
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4345
Mailing Address - Country:US
Mailing Address - Phone:503-589-0565
Mailing Address - Fax:503-589-0463
Practice Address - Street 1:1585 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4345
Practice Address - Country:US
Practice Address - Phone:503-589-0565
Practice Address - Fax:503-589-0463
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1124064506OtherEMPLOYER FACILITY NPI
OR137534Medicaid
OR137534Medicaid
OR1124064506OtherEMPLOYER FACILITY NPI
OR113028Medicare ID - Type Unspecified