Provider Demographics
NPI:1245556448
Name:SPARKMAN, JAMES L (SLP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
Last Name:SPARKMAN
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 COFFEE RD
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP004334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist