Provider Demographics
NPI:1942791264
Name:SUNRISE BAY SPEECH AND LANGUAGE THERAPY
Entity type:Organization
Organization Name:SUNRISE BAY SPEECH AND LANGUAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:FELICE
Authorized Official - Last Name:CRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:989-482-8312
Mailing Address - Street 1:925 S LINWOOD BEACH RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48634-9433
Mailing Address - Country:US
Mailing Address - Phone:989-482-8312
Mailing Address - Fax:
Practice Address - Street 1:4191 N EUCLID AVE STE 100
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2408
Practice Address - Country:US
Practice Address - Phone:989-482-8312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty