Provider Demographics
NPI:1124466917
Name:SUN RIVER SPEECH THERAPY, LLC
Entity type:Organization
Organization Name:SUN RIVER SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:OBERHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:509-521-4034
Mailing Address - Street 1:309 BRADLEY BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4381
Mailing Address - Country:US
Mailing Address - Phone:509-521-4034
Mailing Address - Fax:855-659-0687
Practice Address - Street 1:309 BRADLEY BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4381
Practice Address - Country:US
Practice Address - Phone:509-521-4034
Practice Address - Fax:855-659-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60201290261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech