Provider Demographics
NPI:1437309408
Name:POTTS, SONYA L (MEDCCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:L
Last Name:POTTS
Suffix:
Gender:F
Credentials:MEDCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 N LOOP 1604 E # 105-410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1339
Mailing Address - Country:US
Mailing Address - Phone:210-913-4751
Mailing Address - Fax:210-479-1801
Practice Address - Street 1:18734 MILLHOLLOW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4256
Practice Address - Country:US
Practice Address - Phone:210-913-4751
Practice Address - Fax:210-479-1801
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18614235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163129301Medicaid