Provider Demographics
NPI:1235920356
Name:SPARKS, HEATHER RENEE
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:RENEE
Last Name:SPARKS
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 1:1464 BACK ST
Mailing Address - Street 2:
Mailing Address - City:RARDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45671-9033
Mailing Address - Country:US
Mailing Address - Phone:386-337-9344
Mailing Address - Fax:
Practice Address - Street 1:10400 BLACKLICK EASTERN RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8235
Practice Address - Country:US
Practice Address - Phone:386-337-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator