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NPI Code Detail

MEDICARE: MRS. NATALIE C SPARKS M.A., B.C.B.A

MEDICARE: MRS. NATALIE C SPARKS M.A., B.C.B.A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-13-13104MI

General Provider Information

NPI Number : 1063752905
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NATALIE C SPARKS M.A., B.C.B.A
Provider Business Mailing Address
First Line : 3840 PACKARD ST
Second Line : SUITE 170
City : ANN ARBOR
State : MI
Zip : 48108-2280
Country : US
Telephone Number : 734-528-2013
Fax Number : 734-528-2013
Provider Business Practice Location Address
First Line : 3435 W 96TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-1102
Country : US
Telephone Number : 317-802-7447
Fax Number : 317-802-7325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2013
Last Update Date : 06/14/2019

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