Provider Demographics
NPI:1972232908
Name:WALTERS, SOPHIA LUCILLE (MA, CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:LUCILLE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 SW BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8759
Mailing Address - Country:US
Mailing Address - Phone:269-271-6800
Mailing Address - Fax:
Practice Address - Street 1:940 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4704
Practice Address - Country:US
Practice Address - Phone:772-334-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10630235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist