Healthcare Provider Details

I. General information

NPI: 1467612564
Provider Name (Legal Business Name): RAMONA PAULA SPARKS-MORELLI M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12399 GRAVOIS RD STE 120
SAINT LOUIS MO
63127-1750
US

IV. Provider business mailing address

12399 GRAVOIS RD STE 120
SAINT LOUIS MO
63127-1750
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-3828
  • Fax: 314-843-3052
Mailing address:
  • Phone: 314-842-3828
  • Fax: 314-843-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number106738
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: