Healthcare Provider Details

I. General information

NPI: 1780780692
Provider Name (Legal Business Name): SOPHIE K SPARLING RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 LIBERTY ST SE
SALEM OR
97302-4345
US

IV. Provider business mailing address

1585 LIBERTY ST SE
SALEM OR
97302-4345
US

V. Phone/Fax

Practice location:
  • Phone: 503-589-0565
  • Fax: 503-589-0463
Mailing address:
  • Phone: 503-589-0565
  • Fax: 503-589-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: