Provider Demographics
NPI:1396878229
Name:HURST, SONYA LE ANN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:LE ANN
Last Name:HURST
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 1:1836 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:BYBEE
Mailing Address - State:TN
Mailing Address - Zip Code:37713-2859
Mailing Address - Country:US
Mailing Address - Phone:423-613-5743
Mailing Address - Fax:
Practice Address - Street 1:5250 WEST ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814
Practice Address - Country:US
Practice Address - Phone:423-318-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP 2115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440981Medicaid
TN4136302OtherBCBS PROVIDER NUMBER