Provider Demographics
NPI:1649400334
Name:SUNSHINE SPEECH THERAPY, INC.
Entity type:Organization
Organization Name:SUNSHINE SPEECH THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SPEECH-LANG PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:910-297-0518
Mailing Address - Street 1:7091 TARRAGON CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9163
Mailing Address - Country:US
Mailing Address - Phone:910-297-9518
Mailing Address - Fax:910-399-5455
Practice Address - Street 1:9443 COTTONWOOD LN SE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9545
Practice Address - Country:US
Practice Address - Phone:910-297-9518
Practice Address - Fax:910-399-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7301235Z00000X
OHST.10813235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412876Medicaid