Individual
PATRICK RAYMOND SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
10 RUPERT ST, MONTE VISTA, CO 81144-1042
(719) 852-3742
Mailing address
7108 SOUTH KANNER HWY, STUART, FL 34997
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-53699
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104515300
—
FL
Enumeration date
10/16/2019
Last updated
06/03/2026
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