Provider Demographics
NPI:1942426572
Name:SPARKMAN SPEECH PATHOLOGISTS INC
Entity Type:Organization
Organization Name:SPARKMAN SPEECH PATHOLOGISTS INC
Other - Org Name:THE SPEECH PATH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SPARKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:209-572-2505
Mailing Address - Street 1:2030 COFFEE RD
Mailing Address - Street 2:C-2
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2413
Mailing Address - Country:US
Mailing Address - Phone:209-572-2505
Mailing Address - Fax:209-572-2509
Practice Address - Street 1:2030 COFFEE RD
Practice Address - Street 2:C-2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2413
Practice Address - Country:US
Practice Address - Phone:209-572-2505
Practice Address - Fax:209-572-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP004334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty