Provider Demographics
NPI:1760625198
Name:REYNOLDS-SPARKS, SARAH LOU (MAED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LOU
Last Name:REYNOLDS-SPARKS
Suffix:
Gender:F
Credentials:MAED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3073 STATE HIGHWAY 2078
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-7100
Mailing Address - Country:US
Mailing Address - Phone:606-286-6044
Mailing Address - Fax:606-286-6044
Practice Address - Street 1:3073 STATE HIGHWAY 2078
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164-7100
Practice Address - Country:US
Practice Address - Phone:606-286-6044
Practice Address - Fax:606-286-6044
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist