Provider Demographics
NPI:1265666069
Name:VAZQUEZ, SONJA MICHELLE (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:MICHELLE
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 GRAND OAK CIR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-2006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8800 GRAND OAK CIR
Practice Address - Street 2:SUITE 450
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-2006
Practice Address - Country:US
Practice Address - Phone:321-422-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist