Provider Demographics
NPI:1629491162
Name:KING, SONYA MARIE (BS)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-1924
Mailing Address - Country:US
Mailing Address - Phone:402-375-5741
Mailing Address - Fax:402-375-3879
Practice Address - Street 1:219 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787-1924
Practice Address - Country:US
Practice Address - Phone:402-375-5741
Practice Address - Fax:402-375-3879
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1275678351Medicaid