Look up the most recent NPI and PECOS records

Kenneth John Sparks

Social Worker

Behavioral Health & Social Service Providers

PECOS Enrollment

This provider is enrolled in PECOS as KENNETH SPARKS.

Based on the most recent information from CMS, provider Kenneth John Sparks is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records today at 10:37 AM.

Profile Details

Provider ID
1154894756
Provider Type
Individual
Full Name
Sparks, Kenneth John
Credential
LMSW

Gender
Male
Sole Proprietor
No
Enumeration Date
1/7/2019
Last Updated
12/17/2024

Contact Information

Practice Location

540 Jenner Dr, Allegan, MI 49010-1517

(269) 673-6617

Unlisted Fax

Mailing Location

540 Jenner Dr, Allegan, MI 49010-1517

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 6801105565 Michigan

Provider Identifiers

ID	Description	Issuer
ID 6801105565	Description Other	Issuer LARA MICHIGAN Michigan

Kenneth John Sparks

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Schuyler, Alison Kay

Gofton, Staci Lyn

Redman, Charles B

Todaro, Lauren

Doyle, Susan E

Boerman, Kathryne

Kelly, Morgan

Hudson, Jennifer Renee

Green, David M

Zwaanstra, Janice Marie