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Individual
TRACI SPARKS JERMYN
Active
Individual
TRACI SPARKS JERMYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5584
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13574
BCBS
NC
01
—
4600072
UNITED HEALTHCARE
—
05
—
7412019
—
NC
01
—
7886558
AETNA
—
01
—
8300041K
MEDICAID CBRS
—
05
—
8300041K
—
NC
01
—
D2281
MEDCOST
—
Enumeration date
12/26/2006
Last updated
05/11/2009
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