Provider Demographics
NPI:1033179171
Name:SPARKS, SUSAN WILKES (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:WILKES
Last Name:SPARKS
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:WILKES
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC/SLP
Mailing Address - Street 1:2228 STARLING ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4200
Mailing Address - Country:US
Mailing Address - Phone:912-264-3141
Mailing Address - Fax:912-264-6190
Practice Address - Street 1:2228 STARLING ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4200
Practice Address - Country:US
Practice Address - Phone:912-264-3141
Practice Address - Fax:912-264-6190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist