Provider Demographics
NPI:1023777042
Name:COOPER, SONIA (PHD, LCP, NCSP)
Entity type:Individual
Prefix:DR
First Name:SONIA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD, LCP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 N BROADVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2121
Mailing Address - Country:US
Mailing Address - Phone:630-699-3130
Mailing Address - Fax:
Practice Address - Street 1:67 N BROADVIEW AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2121
Practice Address - Country:US
Practice Address - Phone:630-699-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TS0200X
IL071.009842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool