Provider Demographics
NPI:1649003369
Name:MCCONNELL, SOPHIA ELLA MARGARET
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ELLA MARGARET
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 PHOENIX DR STE 115
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7392
Mailing Address - Country:US
Mailing Address - Phone:757-261-4475
Mailing Address - Fax:757-222-3156
Practice Address - Street 1:629 PHOENIX DR STE 115
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7392
Practice Address - Country:US
Practice Address - Phone:757-261-4475
Practice Address - Fax:757-222-3156
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204001473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist