Provider Demographics
NPI:1336920479
Name:SPARK SPEECH, LANGUAGE AND LEARNING SERVICES LLC
Entity Type:Organization
Organization Name:SPARK SPEECH, LANGUAGE AND LEARNING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITANY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:423-903-5133
Mailing Address - Street 1:3611 SOURWOOD TRL NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2032
Mailing Address - Country:US
Mailing Address - Phone:423-903-5133
Mailing Address - Fax:
Practice Address - Street 1:3555 KEITH ST NW STE 213
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4375
Practice Address - Country:US
Practice Address - Phone:423-716-2458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech