Healthcare Provider Details

I. General information

NPI: 1033039896
Provider Name (Legal Business Name): SUNRISE SPEECH AND LANGUAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31656 HIGHWAY 200 STE 209
PONDERAY ID
83852-9500
US

IV. Provider business mailing address

388 JIM RD
SANDPOINT ID
83864-7593
US

V. Phone/Fax

Practice location:
  • Phone: 208-219-7695
  • Fax: 855-644-3198
Mailing address:
  • Phone: 208-219-7695
  • 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: HOPE KEENAN
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.A. SLP
Phone: 208-219-7695