Provider Demographics
NPI:1881838803
Name:SONNEKSON, MARY ELIZABETH (MA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:SONNEKSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 REED RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:VT
Mailing Address - Zip Code:05143-8574
Mailing Address - Country:US
Mailing Address - Phone:802-869-2211
Mailing Address - Fax:
Practice Address - Street 1:102 REED RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:VT
Practice Address - Zip Code:05143-8574
Practice Address - Country:US
Practice Address - Phone:802-869-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097-0000690101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health