MEDICARE: SPARC SPEECH AND LANGUAGE THERAPY SERVICES LLC

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	7101000566	MI

General Provider Information

NPI Number	:	1588186829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARC SPEECH AND LANGUAGE THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	23003 GREATER MACK AVE STE A
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-1965
Country	:	US
Telephone Number	:	313-268-6173
Fax Number	:	586-204-3266

Provider Business Practice Location Address
First Line	:	23003 GREATER MACK AVE STE A
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-1965
Country	:	US
Telephone Number	:	313-268-6173
Fax Number	:	586-204-3266

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	MRS. AMY KATHLEEN MCINTYRE
Credential	:	MA-CCC-SLP
Telephone Number	:	313-268-6173

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	12/11/2025

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