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General NPI Number Information
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NPI Number | 1891235222
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Entity Type | Organization
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Legal Business Name | SUNSET KIDS THERAPY
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Dates
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Enumeration Date | 03/04/2017
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Last Update Date | 03/04/2017
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Provider Practice Location Address
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Address Line | 3138 ROOSEVELT ST STE K
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City | CARLSBAD
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State | CA
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Zip | 92008-3022
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Country | US
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Telephone | 619-846-3588
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Fax | 619-923-2918
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Provider Business Mailing Address
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Address Line | 3138 ROOSEVELT ST STE K
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City | CARLSBAD
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State | CA
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Zip | 92008-3022
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Country | US
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Telephone | 619-846-3588
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Fax | 619-923-2918
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | TIFFANY HARRISON
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Credential | M.A., CCC-SLP
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Telephone | 619-846-3588
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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 | 17872
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License Number State | CA
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