Provider Demographics
NPI:1902350929
Name:SPARKER, LEAH KATHLEEN
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:KATHLEEN
Last Name:SPARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:KATHLEEN
Other - Last Name:MCGLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1611 W HARRISON ST
Mailing Address - Street 2:ORTHOPEDIC BUILDING SUITE 530
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4861
Mailing Address - Country:US
Mailing Address - Phone:312-942-9785
Mailing Address - Fax:312-942-7068
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:ORTHOPEDIC BUILDING SUITE 530
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4861
Practice Address - Country:US
Practice Address - Phone:312-942-9785
Practice Address - Fax:312-942-7068
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32672355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant