Provider Demographics
NPI:1073297420
Name:LANTING, SOPHIA DENAE
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:DENAE
Last Name:LANTING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17313 HOSHAW ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-9399
Mailing Address - Country:US
Mailing Address - Phone:219-775-6902
Mailing Address - Fax:
Practice Address - Street 1:100 FITNESS DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-9584
Practice Address - Country:US
Practice Address - Phone:815-928-6185
Practice Address - Fax:779-701-2157
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist