Provider Demographics
NPI:1790559391
Name:WRIGHT, SONJA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:WRIGHT
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:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:IL
Mailing Address - Zip Code:61519-0111
Mailing Address - Country:US
Mailing Address - Phone:309-338-0994
Mailing Address - Fax:
Practice Address - Street 1:104 S. STANLEY STREET
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:IL
Practice Address - Zip Code:61519-0111
Practice Address - Country:US
Practice Address - Phone:309-338-0994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist