| NPI | 1932843422 |
|---|---|
| Doing Business As | SAGE SPARK PSYCHOLOGY |
| Entity Type | Organization |
| Authorized Contact | SUSAN JANETTE POOLE Psychologist 253-254-5232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2022-11-09 |