MEDICARE: MS. MARIANNE A SPARKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1288	AZ

General Provider Information

NPI Number	:	1245372572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIANNE A SPARKS

Provider Business Mailing Address
First Line	:	5200 E. RIVER ROAD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718
Country	:	US
Telephone Number	:	520-299-1701
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 E. 10TH STREET
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712
Country	:	US
Telephone Number	:	520-232-6900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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