MEDICARE: ZACK H SPARKMAN

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	101YP2500X	Professional Counselor	178.017666	IL

General Provider Information

NPI Number	:	1679219745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACK H SPARKMAN

Provider Business Mailing Address
First Line	:	223 WHITETAIL XING
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-8639
Country	:	US
Telephone Number	:	630-800-7083
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 WHITETAIL XING
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-8639
Country	:	US
Telephone Number	:	630-800-7083
Fax Number	:

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

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	05/10/2022

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Directions to “ ZACK H SPARKMAN ” Practice Location

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