Provider Demographics
NPI:1972232908
Name:WALTERS, SOPHIA LUCILLE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:LUCILLE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7133 W R AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9745
Mailing Address - Country:US
Mailing Address - Phone:269-271-6800
Mailing Address - Fax:
Practice Address - Street 1:7133 W R AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9745
Practice Address - Country:US
Practice Address - Phone:269-271-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10630235Z00000X
MI7101009203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist