Provider Demographics
NPI:1841511888
Name:SPARGO, NANCY DIANE
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:DIANE
Last Name:SPARGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5461A GRAVOIS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2340
Mailing Address - Country:US
Mailing Address - Phone:314-353-1080
Mailing Address - Fax:314-353-8733
Practice Address - Street 1:5461A GRAVOIS AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-2340
Practice Address - Country:US
Practice Address - Phone:314-353-1080
Practice Address - Fax:314-353-8733
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090136761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical