Healthcare Provider Details

I. General information

NPI: 1861317513
Provider Name (Legal Business Name): QUANTUM LEAP LANGUAGE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 MERLIN DR
IDAHO FALLS ID
83404-4952
US

IV. Provider business mailing address

3525 MERLIN DR
IDAHO FALLS ID
83404-4952
US

V. Phone/Fax

Practice location:
  • Phone: 208-206-9613
  • Fax:
Mailing address:
  • Phone: 208-206-9613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SANDRA SUMMERS REDDISH
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MS CCC
Phone: 208-206-9613