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General NPI Number Information
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NPI Number | 1487545307
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Entity Type | Organization
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Legal Business Name | SUNSHINE PEDIATRIC THERAPY, PLLC
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 15 1ST AVE SE
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City | MINOT
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State | ND
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Zip | 58701-3991
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Country | US
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Telephone | 701-500-0104
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Fax |
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Provider Business Mailing Address
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Address Line | 1208 13TH ST SW
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City | MINOT
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State | ND
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Zip | 58701-5784
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Country | US
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Telephone | 701-500-0104
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH-LANGUAGE PATHOLOGIST
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Name | CANDACE RAE LARSON
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Credential | M.S.
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Telephone | 701-500-0104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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