Individual
LISA MARIE SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BRS CASE MANAGER
Contact information
Practice address
3331 VANDENBERG RD, KLAMATH FALLS, OR 97603-3730
(541) 884-4167
(541) 885-6755
Mailing address
3331 VANDENBERG RD, KLAMATH FALLS, OR 97603-3730
(541) 884-4167
(541) 885-6755
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467885145
—
OR
Enumeration date
06/05/2018
Last updated
06/05/2018
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