Provider Demographics
NPI:1659094241
Name:HART, SOPHIA PAIGE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:PAIGE
Last Name:HART
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 S HAYES ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-7631
Mailing Address - Country:US
Mailing Address - Phone:405-640-8377
Mailing Address - Fax:
Practice Address - Street 1:401 S 3RD ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5737
Practice Address - Country:US
Practice Address - Phone:580-548-1164
Practice Address - Fax:805-977-1882
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5715235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist