Healthcare Provider Details

I. General information

NPI: 1215849419
Provider Name (Legal Business Name): SPARKLE INITIATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 W CLEARWATER AVE STE B100
KENNEWICK WA
99336-2791
US

IV. Provider business mailing address

522 N JEAN ST
KENNEWICK WA
99336-3403
US

V. Phone/Fax

Practice location:
  • Phone: 509-870-7437
  • Fax:
Mailing address:
  • Phone: 509-870-7437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVEN COX
Title or Position: MANAGER
Credential:
Phone: 509-870-7437