Individual
GRACIE SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
619 N 30TH ST, PADUCAH, KY 42001-4047
(270) 444-7898
Mailing address
1102 ELM ST # SR, BENTON, KY 42025-1554
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BACB559713
KY
Other
Enumeration date
09/28/2023
Last updated
09/28/2023
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