Provider Demographics
NPI:1043293046
Name:ACKERMAN, SONIA S (MED, CCC-S)
Entity Type:Individual
Prefix:MS
First Name:SONIA
Middle Name:S
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:MED, CCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11024 N 28TH DR
Mailing Address - Street 2:SUITE #200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4336
Mailing Address - Country:US
Mailing Address - Phone:602-942-3131
Mailing Address - Fax:602-548-6057
Practice Address - Street 1:11024 N 28TH DR
Practice Address - Street 2:SUITE #200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4336
Practice Address - Country:US
Practice Address - Phone:602-942-3131
Practice Address - Fax:602-548-6057
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0162235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ200730033OtherTIN