Healthcare Provider Details

I. General information

NPI: 1275437063
Provider Name (Legal Business Name): JOHNE SPARKMAN CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7465 POWELL RD
GEORGETOWN SC
29440-5436
US

IV. Provider business mailing address

7465 POWELL RD
GEORGETOWN SC
29440-5436
US

V. Phone/Fax

Practice location:
  • Phone: 843-605-8779
  • Fax:
Mailing address:
  • Phone: 843-605-8779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9929
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: