Provider Demographics
NPI:1467886200
Name:NELSON, SOPHIA MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CHARAN WAY
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-7154
Mailing Address - Country:US
Mailing Address - Phone:805-441-1265
Mailing Address - Fax:
Practice Address - Street 1:155 CHARAN WAY
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-7154
Practice Address - Country:US
Practice Address - Phone:805-441-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9060235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist