Basic Information
| Provider Information | |||||||||
| NPI: | 1861563223 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNSHINE SPEECH-LANGUAGE THERAPY SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25615 N RANCH GATE RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852552141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805027726 | ||||||||
| FaxNumber: | 4805134628 | ||||||||
| Practice Location | |||||||||
| Address1: | 25615 N RANCH GATE RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852552141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805027726 | ||||||||
| FaxNumber: | 4805134628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GIER | ||||||||
| AuthorizedOfficialFirstName: | KRISTIN | ||||||||
| AuthorizedOfficialMiddleName: | GOMMEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, DIRECTOR, SPEECH PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4805027726 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA, CCC SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | SLP 1439 | AZ | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 581638 | 01 | AZ | AHCCCS GROUP PROVIDER ID | OTHER |