Basic Information
| Provider Information | |||||||||
| NPI: | 1679828412 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPARKMAN | ||||||||
| FirstName: | SUSANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3298 DEPARTMENT | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601220021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614788770 | ||||||||
| FaxNumber: | 5615987231 | ||||||||
| Practice Location | |||||||||
| Address1: | 12500 WORLD PLAZA LN | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339073988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399311283 | ||||||||
| FaxNumber: | 2399311105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2012 | ||||||||
| LastUpdateDate: | 07/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AZ637 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.