Provider Demographics
NPI:1093985061
Name:SPARKS, KAREN J (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:J
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 WEST LN
Mailing Address - Street 2:PO 123
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9640
Mailing Address - Country:US
Mailing Address - Phone:716-627-0013
Mailing Address - Fax:
Practice Address - Street 1:5716 WEST LN
Practice Address - Street 2:PO 123
Practice Address - City:LAKE VIEW
Practice Address - State:NY
Practice Address - Zip Code:14085-9640
Practice Address - Country:US
Practice Address - Phone:716-627-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007876-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist