Provider Demographics
NPI:1376804625
Name:WITHEM, SOFIA
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:WITHEM
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 1:3635 DUPLEX DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3807
Mailing Address - Country:US
Mailing Address - Phone:503-390-5637
Mailing Address - Fax:
Practice Address - Street 1:2645 PORTLAND RD NE
Practice Address - Street 2:STE 120
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0198
Practice Address - Country:US
Practice Address - Phone:503-390-5637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter