Provider Demographics
NPI:1073839908
Name:SUNSET SPEECH AND LANGUAGE PATHOLOGY, LLC
Entity Type:Organization
Organization Name:SUNSET SPEECH AND LANGUAGE PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:BERRY
Authorized Official - Last Name:BAETIONG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:305-740-9688
Mailing Address - Street 1:5901 SW 74TH ST
Mailing Address - Street 2:SUITE 411
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5165
Mailing Address - Country:US
Mailing Address - Phone:305-740-9688
Mailing Address - Fax:305-428-9521
Practice Address - Street 1:5901 SW 74TH ST
Practice Address - Street 2:SUITE 411
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5165
Practice Address - Country:US
Practice Address - Phone:305-740-9688
Practice Address - Fax:305-428-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8367251C00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency