Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Miranda Sullivan, MS, CCC-SLP

Individual provider Speech-Language Pathologist · NPI 1124600697

Miranda Sullivan, MS, CCC-SLP is a Speech-Language Pathologist in Eagle, Idaho. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
MS — Master of Science
A graduate science degree.
CCC-SLP — Certificate of Clinical Competence in Speech-Language Pathology
A speech-language pathologist certified by ASHA.

See every abbreviation used in this directory →

Practice location Address checks out

449 S Fitness Pl
Eagle, ID 83616-6828
Phone: (208) 957-6301
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X

Record details

NPI number1124600697
Entity typeIndividual (Type 1)
GenderFemale
Credentials MS , CCC-SLP
Sole proprietorNo
NPI enumeratedApril 24, 2021
Last updated in NPPESApril 24, 2021
Certification dateApril 24, 2021
Mailing address2920 W Jefferson St, Boise, ID 83702-4614

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