MEDICARE: JONATHAN PAUL SPARKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCAPRE195667	OH

General Provider Information

NPI Number	:	1528905932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN PAUL SPARKS

Provider Business Mailing Address
First Line	:	8725 PALMER RD NW
Second Line	:
City	:	PATASKALA
State	:	OH
Zip	:	43062-8305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8725 PALMER RD NW
Second Line	:
City	:	PATASKALA
State	:	OH
Zip	:	43062-8305
Country	:	US
Telephone Number	:	614-657-8006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2026
Last Update Date	:	05/07/2026

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Directions to “ JONATHAN PAUL SPARKS ” Practice Location

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