Provider Demographics
NPI:1801235767
Name:TILTON, SOFIA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:TILTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 MEMORIAL DR STE 302
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8008
Mailing Address - Country:US
Mailing Address - Phone:832-794-9007
Mailing Address - Fax:855-482-9603
Practice Address - Street 1:5900 MEMORIAL DR
Practice Address - Street 2:SUITE #208
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-8004
Practice Address - Country:US
Practice Address - Phone:832-794-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist