Provider Demographics
NPI:1932625613
Name:SPARKS, BRITTNEY LYNEE' (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:LYNEE'
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:BRITTNEY
Other - Middle Name:LYNEE'
Other - Last Name:BAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3455 POLO RD STE 108
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4860
Mailing Address - Country:US
Mailing Address - Phone:336-816-6336
Mailing Address - Fax:
Practice Address - Street 1:3455 POLO RD STE 108
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-816-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist