Healthcare Provider Details

I. General information

NPI: 1467110577
Provider Name (Legal Business Name): ERIC JAMES SPARROW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 3RD ST
ELYRIA OH
44035-5618
US

IV. Provider business mailing address

2705 SNOW RD APT 102
PARMA OH
44134-2971
US

V. Phone/Fax

Practice location:
  • Phone: 440-323-5707
  • Fax:
Mailing address:
  • Phone: 216-456-6832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: