Provider Demographics
NPI:1619744588
Name:STALKER, SONYA (SWA)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:STALKER
Suffix:
Gender:F
Credentials:SWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 SWANK DR
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1509
Mailing Address - Country:US
Mailing Address - Phone:330-329-4721
Mailing Address - Fax:
Practice Address - Street 1:300 E BUSINESS WAY STE 200-2465
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2384
Practice Address - Country:US
Practice Address - Phone:614-610-1396
Practice Address - Fax:614-610-1396
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHW.1900161251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management