Healthcare Provider Details

I. General information

NPI: 1548805385
Provider Name (Legal Business Name): REBECCA LOU SPARKMAN PHD, LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 S CHECK ST STE 208
WASILLA AK
99654-8067
US

IV. Provider business mailing address

1075 S CHECK ST STE 208
WASILLA AK
99654-8067
US

V. Phone/Fax

Practice location:
  • Phone: 907-521-8504
  • Fax:
Mailing address:
  • Phone: 907-521-8504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number182168
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: