Provider Demographics
NPI:1205348406
Name:SOPHRIN, LEAH (MS, SLP-CCC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:SOPHRIN
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 BARRE ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3625
Mailing Address - Country:US
Mailing Address - Phone:802-498-3343
Mailing Address - Fax:
Practice Address - Street 1:71 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-5644
Practice Address - Country:US
Practice Address - Phone:802-485-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0114996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist