Provider Demographics
NPI:1063752905
Name:SPARKS, NATALIE C (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:C
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 PACKARD ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2280
Mailing Address - Country:US
Mailing Address - Phone:734-528-2013
Mailing Address - Fax:734-528-2013
Practice Address - Street 1:3435 W 96TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1102
Practice Address - Country:US
Practice Address - Phone:317-802-7447
Practice Address - Fax:317-802-7325
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-13-13104103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst