Provider Demographics
NPI:1124535273
Name:SPRADLEY, SONYA DIANN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:DIANN
Last Name:SPRADLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7651 LAUREL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5000
Mailing Address - Country:US
Mailing Address - Phone:609-533-9438
Mailing Address - Fax:
Practice Address - Street 1:14260 METROPOLIS AVE STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4436
Practice Address - Country:US
Practice Address - Phone:239-400-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16735235Z00000X
FLSZ8069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist