Individual
SPARKLE L NICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10508 CHURCHILL DR, PEORIA, IL 61615-1178
(309) 706-3676
Mailing address
2610 W RICHWOODS BLVD, PEORIA, IL 61604-7112
(309) 323-6648
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
10/21/2020
Last updated
10/21/2020
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