Provider Demographics
NPI:1962856526
Name:ASHLEY, SPARKLE
Entity type:Individual
Prefix:MRS
First Name:SPARKLE
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SPARKLE
Other - Middle Name:
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3801 N 88TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2706
Mailing Address - Country:US
Mailing Address - Phone:414-466-3450
Mailing Address - Fax:
Practice Address - Street 1:3801 N 88TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2706
Practice Address - Country:US
Practice Address - Phone:414-466-9450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM0801X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health