Provider Demographics
NPI:1659121390
Name:SPARKLE SPEECH PATHOLOGY, LLC
Entity Type:Organization
Organization Name:SPARKLE SPEECH PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MALEIGHNA
Authorized Official - Middle Name:LAUREL
Authorized Official - Last Name:CADE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:239-771-0141
Mailing Address - Street 1:1240 FRIENDSHIP WAY
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2195
Mailing Address - Country:US
Mailing Address - Phone:239-771-0141
Mailing Address - Fax:
Practice Address - Street 1:1240 FRIENDSHIP WAY
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-2195
Practice Address - Country:US
Practice Address - Phone:239-771-0141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty