Provider Demographics
NPI:1447845078
Name:SUN RISES SPEECH & LANGUAGE SERVICES, PLLC
Entity type:Organization
Organization Name:SUN RISES SPEECH & LANGUAGE SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:CRISTY
Authorized Official - Last Name:BANCAYAN-TOMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:512-644-0736
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-0432
Mailing Address - Country:US
Mailing Address - Phone:512-644-0736
Mailing Address - Fax:
Practice Address - Street 1:25928 HAYNIE FLAT RD
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-1483
Practice Address - Country:US
Practice Address - Phone:512-644-0736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty