| Doctor Name: | JEANINE B SPARKS |
| NPI Number: | 1104063056 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 512 |
| Business Practice Address: | 491 N Knik St Wasilla, AK - 996547049 |
| Business Phone Number: | 9077278103 |
| Business Fax Number: | |
| Mailing Address: | 491 N Knik St, WASILLA |
| State: | AK |
| Postal Code: | 996547049 |
| Phone Number: | 9077278103 |
| Fax Number: | |
| NPI Enumeration Date: | 01/14/2009 |
| NPI Last Update Date: | 01/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 512 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |