Healthcare Provider Details

I. General information

NPI: 1528905932
Provider Name (Legal Business Name): JONATHAN PAUL SPARKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 PALMER RD NW
PATASKALA OH
43062-8305
US

IV. Provider business mailing address

8725 PALMER RD NW
PATASKALA OH
43062-8305
US

V. Phone/Fax

Practice location:
  • Phone: 614-657-8006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE195667
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: