Active NPI
Jeanine B Sparks, LPC
- Professional Counselor
- Wasilla, AK
National Provider Identifier
1104063056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 512
- Practice address
- 491 N Knik St
Wasilla, AK 99654-7049 - Phone
- (907) 727-8103
- NPI assigned
- Jan 14, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 512 | AK | Primary |
Addresses
Primary practice location
491 N Knik St
Wasilla, AK 99654-7049
Mailing address
491 N Knik St
Wasilla, AK 99654-7049
Phone (907) 727-8103
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 512 | AK | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231891200000",
"number": "1104063056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "491 N KNIK ST",
"city": "WASILLA",
"state": "AK",
"postal_code": "996547049",
"telephone_number": "907-727-8103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "491 N KNIK ST",
"city": "WASILLA",
"state": "AK",
"postal_code": "996547049",
"telephone_number": "907-727-8103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPARKS",
"first_name": "JEANINE",
"middle_name": "B",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-14",
"last_updated": "2009-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AK",
"license": "512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.