Provider Demographics
NPI:1700464724
Name:PERRY, SOPHIA ELAINE
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ELAINE
Last Name:PERRY
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 1:1320 BAUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1903
Mailing Address - Country:US
Mailing Address - Phone:314-528-9509
Mailing Address - Fax:
Practice Address - Street 1:1320 BAUR BLVD
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-1903
Practice Address - Country:US
Practice Address - Phone:314-528-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician