Provider Demographics
NPI:1619921954
Name:SONNENBERG, JOSEPH PATRICK (MS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:SONNENBERG
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6479 OLD LAKE SHORE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9731
Mailing Address - Country:US
Mailing Address - Phone:716-573-5710
Mailing Address - Fax:
Practice Address - Street 1:50 E NORTH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1002
Practice Address - Country:US
Practice Address - Phone:716-885-8871
Practice Address - Fax:716-885-4229
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000058-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist