Provider Demographics
NPI:1174278113
Name:SUNSTREET SPEECH THERAPY
Entity Type:Organization
Organization Name:SUNSTREET SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JODANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALIEN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:407-760-0063
Mailing Address - Street 1:2542 CLIFFDALE ST
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4772
Mailing Address - Country:US
Mailing Address - Phone:407-760-0063
Mailing Address - Fax:
Practice Address - Street 1:2542 CLIFFDALE ST
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4772
Practice Address - Country:US
Practice Address - Phone:407-760-0063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty