Miranda Sullivan, MS, CCC-SLP

Speech-Language Pathologist · Eagle, ID

Individual Active NPI

NPI number 1124600697

Practice location

449 S Fitness Pl
Eagle, ID 83616-6828
Phone
(208) 957-6301

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NPI record

NPI
1124600697
Entity type
Individual (Type 1)
Enumeration date
April 24, 2021
Last updated
April 24, 2021
Certified
April 24, 2021
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Speech-Language Pathologist Primary 235Z00000X — —

Mailing address

2920 W Jefferson St
Boise, ID 83702-4614
Phone
(208) 249-4890

About Miranda Sullivan

Miranda Sullivan, MS, CCC-SLP is a healthcare provider registered in the NPI registry with the primary taxonomy Speech-Language Pathologist (code 235Z00000X). The practice location is 449 S Fitness Pl, Eagle, ID 83616-6828. The NPI number 1124600697 was assigned on April 24, 2021 and the record was last updated on April 24, 2021.

Frequently asked questions

What is the NPI number of Miranda Sullivan, MS, CCC-SLP?

The NPI number is 1124600697.

What is the phone number of Miranda Sullivan?

The phone number listed for the practice location is (208) 957-6301.

Where is Miranda Sullivan located?

449 S Fitness Pl, Eagle, ID 83616-6828.

What is the taxonomy code for Miranda Sullivan?

The primary taxonomy code is 235Z00000X – Speech-Language Pathologist.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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