Spark Therapy, LLC
NPI #1538025382 in Vicksburg, Mississippi
Provider Information
- NPI Number
- 1538025382
- Entity Type
- Organization
- Organization Name
- Spark Therapy, LLC
- Primary Specialty
- Speech-Language Pathologist
- Enumeration Date
- Dec 24, 2025
- Last Updated
- Dec 24, 2025
Practice Location
- Address
- 5289 YOUNGTON RD
- City
- Vicksburg
- State
- Mississippi
- ZIP Code
- 39183-7116
- Phone
- (601) 618-1510
Authorized Official
- Name
- BETTY J CHILES, RHIT
- Title
- CREDENTIALING SPECIALIST
- Phone
- (601) 618-5120
Specialties & Taxonomy Codes
| Specialty |
|---|
| Speech-Language Pathologist |
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