Provider Demographics
NPI:1093550725
Name:SUNRISE SPEECH THERAPY LLC
Entity type:Organization
Organization Name:SUNRISE SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DYE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:940-839-9686
Mailing Address - Street 1:118 EDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-4285
Mailing Address - Country:US
Mailing Address - Phone:940-839-9686
Mailing Address - Fax:
Practice Address - Street 1:118 EDGEWOOD CIR
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003-4285
Practice Address - Country:US
Practice Address - Phone:940-839-9686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech