Provider Demographics
NPI:1619533494
Name:SPARKLE 'WHERE OUR VOICES SHINE' INC.
Entity Type:Organization
Organization Name:SPARKLE 'WHERE OUR VOICES SHINE' INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEAUNNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-594-5409
Mailing Address - Street 1:420 W BASELINE RD STE E
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4817
Mailing Address - Country:US
Mailing Address - Phone:626-594-5409
Mailing Address - Fax:
Practice Address - Street 1:420 W BASELINE RD STE D
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4817
Practice Address - Country:US
Practice Address - Phone:626-594-5409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty