MEDICARE: MRS. MARY SUE SPARKMAN MSW, LCSW

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
1	1041C0700X	Clinical Social Worker	1714	OK

General Provider Information

NPI Number	:	1467548172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY SUE SPARKMAN MSW, LCSW

Provider Business Mailing Address
First Line	:	2405 NW 50TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8011
Country	:	US
Telephone Number	:	405-843-6456
Fax Number	:	405-843-6456

Provider Business Practice Location Address
First Line	:	2405 NW 50TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8011
Country	:	US
Telephone Number	:	405-843-6456
Fax Number	:	405-843-6456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	03/19/2009

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