| Spark Behavior Consulting | |
|
11470 Sunrise Gold Cir Ste 7 Rancho Cordova CA 95742-6541 | |
| (916) 526-0722 | |
| (855) 365-1125 |
| Full Name | Spark Behavior Consulting |
|---|---|
| Speciality | Behavior Analyst |
| Location | 11470 Sunrise Gold Cir Ste 7, Rancho Cordova, California |
| Authorized Official Name and Position | Ian Glen Wilson (CEO) |
| Authorized Official Contact | 9165260722 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spark Behavior Consulting 11470 Sunrise Gold Cir Ste 7 Rancho Cordova CA 95742-6541 Ph: (916) 526-0722 | Spark Behavior Consulting 11470 Sunrise Gold Cir Ste 7 Rancho Cordova CA 95742-6541 Ph: (916) 526-0722 |
| NPI Number | 1538567334 |
|---|---|
| Provider Enumeration Date | 12/10/2014 |
| Last Update Date | 12/10/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538567334 | NPI | - | NPPES |
| 1568781615 | Other | CA | CURRENT NPI NUMBER (PERSONAL) |
| 12421587 | Other | CA | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1084578 (California) | Primary |
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