Provider Demographics
NPI:1760971808
Name:WOOL, SONYA ROSE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:ROSE
Last Name:WOOL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 W EMERALD ST STE A150
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2027
Mailing Address - Country:US
Mailing Address - Phone:208-906-1441
Mailing Address - Fax:
Practice Address - Street 1:4477 W EMERALD ST STE A150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2027
Practice Address - Country:US
Practice Address - Phone:208-906-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-349171100000X
IDACU349171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist