Provider Demographics
NPI:1699891648
Name:SPARKE, WILLIAM P (LICSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:P
Last Name:SPARKE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 9TH AVENUE CIR S
Mailing Address - Street 2:#111
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7042
Mailing Address - Country:US
Mailing Address - Phone:701-478-9550
Mailing Address - Fax:
Practice Address - Street 1:4227 9TH AVE SW
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2018
Practice Address - Country:US
Practice Address - Phone:701-282-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDLICSW# 43301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical