Provider Demographics
NPI:1508640673
Name:SUNRISE SPEECH THERAPY
Entity Type:Organization
Organization Name:SUNRISE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KJIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEETCH
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:801-980-1510
Mailing Address - Street 1:7213 N SILVER CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5191
Mailing Address - Country:US
Mailing Address - Phone:520-665-8023
Mailing Address - Fax:
Practice Address - Street 1:4095 E PONY EXPRESS PKWY STE 12
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5531
Practice Address - Country:US
Practice Address - Phone:801-980-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech