Provider Demographics
NPI:1740315647
Name:SUNLIGHT SPEECH & LANGUAGE SERVICES, INC.
Entity type:Organization
Organization Name:SUNLIGHT SPEECH & LANGUAGE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:NANNENGA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:307-587-4115
Mailing Address - Street 1:556 ROAD 2AB
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8217
Mailing Address - Country:US
Mailing Address - Phone:307-587-4115
Mailing Address - Fax:307-587-4115
Practice Address - Street 1:556 ROAD 2AB
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8217
Practice Address - Country:US
Practice Address - Phone:307-587-4115
Practice Address - Fax:307-587-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty