Provider Demographics
NPI:1922212885
Name:SOPKO, MARY H (SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:H
Last Name:SOPKO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3964 PINE LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9570
Mailing Address - Country:US
Mailing Address - Phone:330-659-0748
Mailing Address - Fax:330-659-2347
Practice Address - Street 1:3964 PINE LAKE CIR
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9570
Practice Address - Country:US
Practice Address - Phone:330-687-5680
Practice Address - Fax:330-659-2347
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3232235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist