Provider Demographics
NPI:1518528132
Name:BARENIE, SOPHIE (MA CC-SLP)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:BARENIE
Suffix:
Gender:F
Credentials:MA CC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 N WILLOW RD APT 315
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-1134
Mailing Address - Country:US
Mailing Address - Phone:219-677-8185
Mailing Address - Fax:
Practice Address - Street 1:1000 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4644
Practice Address - Country:US
Practice Address - Phone:217-258-2568
Practice Address - Fax:217-238-3420
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-014970235Z00000X
IL242005130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist