Provider Demographics
NPI:1629213582
Name:SONNENBERG, MARIE ELANA (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ELANA
Last Name:SONNENBERG
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:MISS
Other - First Name:MARIE
Other - Middle Name:ELANA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1879 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4530
Mailing Address - Country:US
Mailing Address - Phone:917-302-7973
Mailing Address - Fax:
Practice Address - Street 1:1879 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4530
Practice Address - Country:US
Practice Address - Phone:917-302-7973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016273-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist