Basic Information
| Provider Information | |||||||||
| NPI: | 1720372360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPARKMAN | ||||||||
| FirstName: | COLEEN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5157 | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953525157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095722589 | ||||||||
| FaxNumber: | 2095721461 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 14TH ST | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953541003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095722589 | ||||||||
| FaxNumber: | 2095721461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2011 | ||||||||
| LastUpdateDate: | 08/06/2013 | ||||||||
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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 | 235Z00000X | SP-3815 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.